Recently, the UK’s Driver & Vehicle Licencing Agency (DVLA) published updated guidance for medical professionals on assessing fitness to drive.1 This included updates for adults with congenital heart disease (ACHD) and a new section for those with pulmonary hypertension. There is some overlap in these conditions, with pulmonary arterial hypertension (PAH) affecting 5–10% of congenital heart disease patients. Both PAH and ACHD are the remit of the specialist, and in both conditions social independence and psychological wellbeing are key goals of care. Driving can enhance an individual’s independence by facilitating engagement in social roles, including employment, family life and peer relationships. In the presence of medical conditions that can significantly affect exercise tolerance, this freedom must be balanced against the risk of a sudden disabling event.
In the new guidance, anyone with ACHD and symptoms, including any severity of palpitations or breathlessness, must stop driving immediately and must notify the DVLA. Patients with PAH who are under the care of a specialist centre may only drive after specialist assessment, and only if the assessment concludes that there is an annual risk of a disabling event of <20%. The requirements are even stricter for group 2 licence holders. Failure to disclose a medical condition that affects driving eligibility can lead to a fine of up to £1000, and criminal prosecution if driving results in a road traffic collision.
These changes are significant. Previously, patients with either condition could continue to hold a group 1 licence provided there was “no other disqualifying condition”. Under the new guidance, however, patients with symptomatic congenital heart disease may face a blanket ban on driving.