Heart Failure

The prognosis for heart failure (HF) depends on the underlying disease; however, the driving risks for HF do not. Sudden death is responsible for 10% to 30% of all deaths in individuals with severe symptoms. Even in mildly symptomatic individuals, sudden death accounts for the majority of deaths.

• Coronary heart disease (CHD) is the major cause of systolic dysfunction.
• Hypertension is the cause or associated factor in the development of HF among individuals with a nonischemic etiology.
• Idiopathic dilated cardiomyopathy is the most frequent diagnosis of individuals who present with systolic dysfunction and no evidence of significant underlying coronary artery disease.

NOTE: Congestive heart failure is the terminology used in the Cardiovascular Advisory Panel Guidelines for the Medical Examination of Commercial Motor Vehicle Drivers.

Waiting period

No recommended time frame

You should not certify the driver until etiology is confirmed and treatment has been shown to be adequate/effective, safe, and stable.

Decision

Maximum certification period — 1 year

Recommend to certify if:

The driver:

• Is asymptomatic at examination.
• Tolerates medication.
• Has exercise tolerance test results greater than 6 METs (metabolic equivalents).
• Has a left ventricular ejection fraction (LVEF) greater than or equal to 40%.

Recommend not to certify if:

The driver:

• Has symptomatic HF regardless of systolic function.
• Is asymptomatic with an LVEF less than or equal to 50% and has ventricular arrhythmias (sustained or nonsustained ventricular tachycardia or symptomatic palpitations).
• Is asymptomatic and has an LVEF less than 40%.

Monitoring/Testing

The driver should obtain:

• Annual evaluation and clearance from a cardiovascular specialist who understands the functions and demands of commercial driving, including:
  • Echocardiography.
  • Holter monitoring.

Follow-up

The driver should have an annual medical examination.

Cardiomyopathies and Congestive Heart Failure Recommendation Table (PDF)