Baseline Factors Predicting Early Resumption of Driving
Baseline Factors Predicting Early Resumption of Driving
Background: In the Antiarrhythmics Versus Implantable Defibrillators (AVID) Trial, patients with ventricular fibrillation or hemodynamically unstable ventricular tachycardia were randomly assigned to receive either an implantable cardioverter-defibrillator (ICD) or antiarrhythmic drug therapy. As part of the trial, patients were asked to participate in a prospective driving survey. The purpose of the survey was to determine what baseline factors and patient characteristics specifically predicted resumption of driving earlier than advised by current guidelines.
Methods: Patients were surveyed anonymously as to their driving habits in the initial period after random assignment and every 6 months thereafter. AVID study coordinators were independently asked to assess their patients' driving status as well. The relation between baseline factors and time to resumption of driving was explored by means of Kaplan-Meier estimates for univariate analyses and the stepwise Cox proportional hazards regression model for multivariate analyses.
Results: There were 802 patients who were eligible for assessment of driving status. The majority of patients (58%) resumed driving an automobile within 6 months of their index arrhythmia regardless of whether they received drug therapy or an ICD. By multivariate analysis, patients who were younger than 65 years of age, male, and college educated were more likely to drive early, as were patients whose index arrhythmia was ventricular tachycardia.
Conclusions: Younger, college-educated men and those whose index arrhythmia is ventricular tachycardia are most likely to resume driving <6 months after the initiation of therapy for a potentially life-threatening ventricular arrhythmia. Patients with an ICD did not appear to resume driving later than those who were discharged on antiarrhythmic drugs alone.
Life-threatening ventricular arrhythmias occur unpredictably and may incapacitate an individual within seconds. Individuals who have had one arrhythmic episode are at high risk of recurrence. However, many of these patients wish to resume driving after being placed on antiarrhythmic treatment such as antiarrhythmic drug therapy or an implantable cardioverter-defibrillator (ICD). Laws and regulations governing the rights of patients with ventricular arrhythmias to drive motor vehicles vary widely throughout the world. Physicians' instructions to patients about driving resumption are similarly diverse. Recent guidelines issued by the American Heart Association and the North American Society of Pacing and Electrophysiology for patients with ventricular arrhythmias recommend an arrhythmia-free period of 6 months after treatment with either an antiarrhythmic drug or an ICD before driving can be resumed. However, many patients resume driving earlier than physician recommendations.
In the Antiarrhythmics Versus Implantable Defibrillators (AVID) Trial, patients with ventricular fibrillation or hemodynamically unstable ventricular tachycardia, randomly assigned to receive either an ICD or antiarrhythmic drug therapy (mostly amiodarone), were asked to participate in a prospective driving survey. One of the purposes of this survey was to determine what baseline factors and patient characteristics were associated with resumption of driving, and in particular, whether any factors or characteristics specifically predicted resumption of driving earlier than that advised by current guidelines.
Background: In the Antiarrhythmics Versus Implantable Defibrillators (AVID) Trial, patients with ventricular fibrillation or hemodynamically unstable ventricular tachycardia were randomly assigned to receive either an implantable cardioverter-defibrillator (ICD) or antiarrhythmic drug therapy. As part of the trial, patients were asked to participate in a prospective driving survey. The purpose of the survey was to determine what baseline factors and patient characteristics specifically predicted resumption of driving earlier than advised by current guidelines.
Methods: Patients were surveyed anonymously as to their driving habits in the initial period after random assignment and every 6 months thereafter. AVID study coordinators were independently asked to assess their patients' driving status as well. The relation between baseline factors and time to resumption of driving was explored by means of Kaplan-Meier estimates for univariate analyses and the stepwise Cox proportional hazards regression model for multivariate analyses.
Results: There were 802 patients who were eligible for assessment of driving status. The majority of patients (58%) resumed driving an automobile within 6 months of their index arrhythmia regardless of whether they received drug therapy or an ICD. By multivariate analysis, patients who were younger than 65 years of age, male, and college educated were more likely to drive early, as were patients whose index arrhythmia was ventricular tachycardia.
Conclusions: Younger, college-educated men and those whose index arrhythmia is ventricular tachycardia are most likely to resume driving <6 months after the initiation of therapy for a potentially life-threatening ventricular arrhythmia. Patients with an ICD did not appear to resume driving later than those who were discharged on antiarrhythmic drugs alone.
Life-threatening ventricular arrhythmias occur unpredictably and may incapacitate an individual within seconds. Individuals who have had one arrhythmic episode are at high risk of recurrence. However, many of these patients wish to resume driving after being placed on antiarrhythmic treatment such as antiarrhythmic drug therapy or an implantable cardioverter-defibrillator (ICD). Laws and regulations governing the rights of patients with ventricular arrhythmias to drive motor vehicles vary widely throughout the world. Physicians' instructions to patients about driving resumption are similarly diverse. Recent guidelines issued by the American Heart Association and the North American Society of Pacing and Electrophysiology for patients with ventricular arrhythmias recommend an arrhythmia-free period of 6 months after treatment with either an antiarrhythmic drug or an ICD before driving can be resumed. However, many patients resume driving earlier than physician recommendations.
In the Antiarrhythmics Versus Implantable Defibrillators (AVID) Trial, patients with ventricular fibrillation or hemodynamically unstable ventricular tachycardia, randomly assigned to receive either an ICD or antiarrhythmic drug therapy (mostly amiodarone), were asked to participate in a prospective driving survey. One of the purposes of this survey was to determine what baseline factors and patient characteristics were associated with resumption of driving, and in particular, whether any factors or characteristics specifically predicted resumption of driving earlier than that advised by current guidelines.
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