November 28th 2017
Fitness to drive with cardiovascular disease

Recently, the European regulations regarding  fitness to drive criteria were updated for cardiovascular diseases. The adjustments are based on recommendations of an expert group of the European Commission. The expert group reviewed which revisions were needed due to new scientific knowledge and better treatment options. The permanent Committee on Fitness to Drive of the Health Council of the Netherlands has assessed the consequences of those changes for the Dutch Fitness Criteria Regulations 2000 (REG2000). The Committee advises the Minister of Infrastructure and Water Management to adopt most of them in the REG2000, and in doing so, to maintain the format and formulation of the European expert group, which is more specific. The only disorders for which the Committee advises not to adjust the current regulation are congenital heart defects.

Summary

Having cardiovascular disease may affect your medical fitness to drive. European legislation on this has recently been changed. On request from the Minister of Infrastructure and Water management (I&W), the Health Council of the Netherlands has assessed what this means for Dutch legislation.

The specific requirements for medical fitness to drive for people with cardiovascular disease are laid down in Chapter 6 of the Dutch Fitness Criteria Regulations 2000 (REG2000). That chapter needs an update: the scientific knowledge has changed and treatment options have improved. In 2013, an expert group from the European Commission reviewed ten types of disorders for each driving licence group to determine which revisions are needed in the European driving licence directive. In 2016, the recommendations of the expert group led to changes in this directive.

The Fitness to Drive Committee of the Health Council has assessed the consequences of those changes for Dutch legislation. The Committee supports most of the changes and advises maintaining the format and formulation of the European expert group when processing those adjustments in the REG2000, which is more specific than the European directive. For some disorders, this will lead to a relaxation of the requirements. For cardiac valve defects, the Health Council advises maintaining the European directive, which is stricter than the European expert group on that point. The only disorder for which the Committee advises not adjusting the current regulation is congenital heart defects.

The table below summarises the changes in the European directive based on the recommenda-tions of the expert group and the advice from the Health Council.

  Recommendations from the expert group changes in the European directive Advice from the Health Council
Heart failure Criteria driving licence group 1 more flexible for heart failure class III

Follow recommendations from the expert group

Ischemic heart disease

More specific criteria (distinguish more disorders)

Criteria driving licence group 2 more flexible for stable angina pectoris

Follow recommendations from the expert group Maintain less specific EU rules for acute coronary syndrome

Structural and electrical cardiomyopathy

More specific criteria and supplemented with LQTS and Brugada syndrome

Criteria driving licence group 2 more flexible for hypertrophic cardiomyopathy

Follow recommendations from the expert group

Cardiac valve defects

More detailed criteria

European regulations more stringent than expert group, fewer exceptions for driving licence group 1

Maintain more stringent European regulations

Congenital defects

Expert group would like to shorten the maximum eligibility period for driving licences European directive does not prescribe a maximum period

Do not follow recommendations from the expert group Maintain current period of maximum ten years

Arrhythmias

More specific criteria (distinguish more disorders)

Follow recommendations from the expert group

Ventricular arrhythmia

More specific criteria

Follow recommendations from the expert group
ICD Expert group: apply time limits for driving impairment European directive: no time limits Follow time limits from expert group
Blood pressure Criteria more flexible Follow recommendations from the expert group
Peripheral vascular disorders

Added

Follow recommendations from the expert group