CardiologyTier 2Topic

Restrictions on driving following cardiac illness, as identified by the statutory body

Framework

Governed by *Austroads Assessing Fitness to Drive (AP-G56)*, adopted by every state/territory driver licensing authority
Two distinct outputs from any assessment:
- A. Short-term non-driving period after an event or procedure - advisory, doctor-communicated, not enforceable through licensing
- B. Long-term licence status - unconditional / conditional / not fit to drive
Two licence classes with very different thresholds:
- Private (car, motorcycle) vs Commercial (heavy vehicle, bus, taxi/rideshare)
- Commercial: longer exposure, larger vehicle, greater consequence -> roughly 2-3x the restriction

Treating doctor - assesses, advises, documents, reports to the licensing authority where required
Patient - legal obligation to report a long-term condition affecting driving
Driver licensing authority - the only body that grants, conditions or cancels a licence
You advise; you do not revoke. Document the advice in the notes and the discharge summary - this is medico-legally protective

Cardiac events cause a small fraction of crashes - risk of harm to others is the organising principle, not risk to the patient
Risk-of-harm formula: RH = TD x V x SCI x AC
- Time driving x vehicle type x annual risk of sudden incapacity x probability of a crash causing harm
Accepted annual risk of sudden incapacity: ~1%/yr private, ~0.1%/yr commercial

Sudden incapacity - arrhythmia, syncope, MI, ICD shock
Symptoms impairing control - chest pain, palpitations, breathlessness, presyncope
Post-procedural - sternotomy pain and restricted movement, sedation, groin access site
Drug effects - hypotension, bradycardia

Restriction length tracks the early hazard period for recurrence
- Shortest after an uncomplicated elective procedure
- Longest after an event with high recurrence risk (resuscitated cardiac arrest) or a device implanted for a documented arrhythmia

Is the underlying condition treated and stable?
LVEF - a key modifier (EF <40% shortens nothing but extends commercial restriction; EF very low may preclude commercial licensing)
Residual ischaemia, incomplete revascularisation, planned further procedures
Symptom status: any angina/dyspnoea at the level of exertion driving requires
Arrhythmia recurrence, device therapies delivered
Comorbid: syncope, sleep apnoea, diabetes with hypoglycaemia unawareness, visual fields, cognition
Medical review at the end of the non-driving period, not automatic resumption

Suggested non-driving periods - private / commercial

Advisory minimums. Verify against the current Austroads edition before quoting - the 2026-28 review is under way.

Event / procedure	Private	Commercial
Elective PCI, uncomplicated	2 days	4 weeks
ACS / MI (with or without PCI)	2 weeks	4 weeks
CABG	4 weeks	3 months
Valve surgery	4 weeks	3 months
Aortic aneurysm repair	4 weeks	3 months
Catheter ablation (SVT/AF)	2 days	4 weeks
Pacemaker insertion	2 weeks	4 weeks
ICD - primary prevention	2 weeks	*Not permitted*
ICD - secondary prevention (implanted after VT/VF)	6 months	*Not permitted*
ICD - appropriate therapy delivered (shock or ATP)	4 weeks	Not permitted
Generator/lead replacement	2 weeks	4 weeks
Resuscitated cardiac arrest / sustained VT	6 months	Not permitted
Cardiogenic syncope	>=4 weeks	>=3 months
Unexplained syncope (single, low risk)	4 weeks	3 months
VTE / PE on established anticoagulation	2 weeks	4 weeks
Heart transplant	6 weeks	Conditional, specialist-dependent

ICD in situ -> commercial unconditional licence is not granted, irrespective of time elapsed
- Risk of sudden incapacity from the underlying disease plus inappropriate shock
NYHA III-IV heart failure or EF severely reduced -> conditional private licence, not fit for commercial
Uncontrolled arrhythmia, symptomatic AS, unrepaired large aortic aneurysm -> not fit until treated
Cyanotic or complex congenital heart disease, PAH -> specialist-determined conditional licence

Ask what they drive and for a living at every cardiac presentation - a taxi or truck driver has a different conversation
Give the advice verbally and in writing; document it and copy the GP
Where the patient will not comply and risk is significant: doctors may report directly to the licensing authority
- Protected from civil/criminal liability for good-faith reporting in all Australian jurisdictions
Patients must notify their insurer as well - driving against advice may void cover
Loss of licence has major occupational and psychological impact - arrange follow-up and support, not just a prohibition

Blackouts chapter of Austroads covers syncope and seizures - apply whichever restriction is longer
Diabetes - severe hypoglycaemia or hypoglycaemia unawareness carries its own standard
Obstructive sleep apnoea - excessive daytime sleepiness is a separate disqualifying condition; common in the same patients
Stroke/TIA - 4 weeks private (TIA), longer after stroke with deficit
Alcohol and other drugs, vision (acuity and fields), and cognition standards apply in parallel
CSANZ / Heart Foundation patient materials mirror the Austroads periods

Non-driving periods are minimum advisory periods, not a guarantee of fitness at the end
Re-assess at the end of the period - symptoms, EF, arrhythmia recurrence, device interrogation
Conditional licences carry periodic review (commonly annual or 2-yearly) with specialist reports
Austroads editions change: 2022 edition currently in force; 2026-28 review commenced - always check the live document before giving a number
The commonest exam and clinical failure is silence: not asking about driving and not documenting the advice

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