What is the legal framework?
When you suffer from a heart rhythm disorder or after a heart incident, it is usually possible to resume driving. This is not always the case, however, and the law has a rather specific framework for the French category B driving license (for standard personal vehicles), which is what will mainly be covered here. The vast majority of conditions require obtaining the approval of the medical authorities before resuming driving, and being given the all-clear, subject to a clinical test and the disappearance of symptoms. This is true for atrial fibrillation and ventricular tachycardia, for instance. Resuming driving after certain incidents may also be subject to a minimum delay, such as waiting four weeks after a myocardial infarction (heart attack). In the event of an operation, it is advised to wait at least four weeks after leaving hospital before driving an automatic car and eight weeks before driving a manual vehicle.
There are a few rare cases of absolute incompatibility, particularly when a portable external defibrillator is worn in the form of a life vest (see box), or in cases of class IV heart failure, as classified by the New York Heart Association (NYHA).
As for driving abroad, the law may vary substantially, even within Europe, since there is no harmonization on this point. It is therefore best to check before you travel to avoid any unfortunate surprises once you get to your destination.
For people fitted with defibrillators
A decree dated March 28, 2022 specifies in which circumstances people who wear implantable cardioverter-defibrillators may continue to drive. It appears that for primary prevention defibrillators — i.e. for people presenting numerous risk factors but who have not had a heart incident —, it is possible to drive four weeks after having one fitted. In secondary prevention — for people who have already had a heart incident — there is a three-month delay. However, wearing a defibrillator life vest inhibits driving: this equipment is intended for people presenting a risk of sudden death.
Advantages and disadvantages
For people who used to drive before their heart rhythm disorder or heart incident, resuming driving may have considerable benefits. Firstly, in terms of their socialization. For some of them, driving is essential on a daily basis, to go food shopping, go to work, visit cultural venues, and even simply attend medical appointments.
Beyond these purely practical and highly important aspects, resuming driving is a way to move forward and can boost your mood, leading to quicker, long-lasting recovery.
In contrast, driving can also be stressful, which increases the risk of heart conditions. Not forgetting that, even if the risk is marginal (see box), it nevertheless exists, for yourself and others, if you have another accident. It is therefore necessary to analyze the situation as closely as possible with your cardiologist to evaluate the risk/benefit balance before resuming driving.
Required tests
To evaluate the ability of a person suffering from a heart rhythm disorder to resume driving, a certain number of clinical exams will be undertaken.
The first consists of a clinical exam. Symptoms such as chest pain, shortness of breath and fainting must have completely disappeared. The heart should have returned to a normal rhythm.
Then there are the functional tests, in particular stress tests, and more specific tests to assess the person’s ability to cope with the physical and emotional stress of driving.
In certain cases, some of their prescribed medication which can affect vigilance may need to be adjusted. The physician is in charge of adjusting the treatment, if possible.
Resuming driving
Once the medical experts have granted their approval, the patient may resume driving. But in order to do so as safely as possible, a few simple rules will need to be observed.
Firstly, resuming driving gradually: beginning with small roads and short journeys to build up confidence and avoiding stressful conditions, such as bad weather or traffic jams. It is also recommended to keep an eye on symptoms: fainting at the wheel can be fatal.
Lastly, contact your insurance provider. They may apply a surcharge, or even warranty exclusions in the event of a heart attack, for instance.
Specific rules for heavy goods vehicles
Resuming driving a heavy goods vehicle after a heart rhythm disorder or heart incident is not impossible but must be done in specific conditions. The driver will need to be examined by a prefecture-approved physician, who may also seek the advice of a cardiologist. This visit must be renewed every five years until the age of 60, then every two years until the age of 76 and every year after.
Fairly rare causes of accidents
Having a road accident due to a health problem is unusual, and is much rarer compared to the three main causes, namely alcohol, speeding and negligence. It nevertheless exists, and was particularly documented in the United Kingdom: a study of nearly 10,000 road accidents showed that only 15 were linked to a medical problem. Another British study specified that only 8% of losses of consciousness at the wheel were due to heart disease, half of which were caused by a heart attack.
