The Expert Consensus Workshop, Driving Safety and Cardiac Ischaemia, was organised to evaluate the currently available assessment tools that determine the most accurate and reliable prognostic indicators of a high cardiovascular event rate while driving, for Group 2 drivers with a history or evidence of established cardiovascular disease. The estimated level of risk of a cardiovascular event is used in making decisions on whether to grant, renew or revoke Group 2 licences on medical grounds. The Driver and Vehicle Licensing Agency (DVLA) has a commitment to continuous improvement in customer care, to ensure up-to-date and objective medical criteria, and to avoid unjustified discrimination. The scientific workshop was convened by the Department for Transport (DfT) to draw on the best medical expertise available in reviewing current practice. The aims of the Workshop were to examine a number of protocol issues, such as: • the value of symptom-limited exercise testing rather than the standard nineminute treadmill test used by the DVLA; • the appropriate interval between revascularisation procedures and exercisetolerance tests; and • the procedure to be undertaken when licence holders or applicants are unable to complete the standard exercise-tolerance test for non-cardiac reasons (such as lower-limb pain or disability). The suitability of stress echocardiography and myocardial perfusion scintigraphy (MPS) in determining cases where exercise-tolerance test results are equivocal was reviewed, as was the role of coronary angiography in providing additional prognostic evidence. Cost–benefit issues were also considered. The Workshop also discussed how to respond to applicants and licence holders who undertake unsolicited medical tests that generate results that conflict with the DVLA test results. Another discussion point was whether other coronary artery disease risk factors, such as age and smoking, should be taken into consideration in decisions about who should undergo exercise-tolerance testing. The Workshop was divided into two parts: a formal review of relevant research evidence; and an open discussion to address current testing protocols and decision making. It also included a review of current practice by the Civil Aviation Authority (CAA) in granting pilots’ licences and whether there are any lessons to be drawn from the higher medical standards – based on lower levels of acceptable risk – used in aviation. Workshop participants included leading cardiologists in the UK, members of the DVLA Cardiac Expert Panel, and medical officers from the DVLA, CAA and DfT. The event was managed by an independent organisation, the At Work Partnership, which was also responsible for writing and editing the workshop proceedings. (Author/publisher)
Abstract