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Road Exposure After Cardioverter-Defibrillator Implantation and its Potential Influence on Reported Motor Vehicle

John A Staples1, Daniel Daly-Grafstein2, Mayesha Khan2

  • 1Division of General Internal Medicine, Department of Medicine, University of British Columbia, Vancouver, Canada; Centre for Clinical Epidemiology & Evaluation (C2E2), Vancouver, Canada.

The American Journal of Cardiology
|November 28, 2025
PubMed
Summary
This summary is machine-generated.

Driving significantly decreases after implantable cardioverter-defibrillator (ICD) implantation, impacting crash risk interpretation. Reduced road exposure is crucial for understanding post-ICD driving safety.

Keywords:
automobile driving standards (MeSH)driver licensingfitness-to-driveimplantable cardioverter defibrillatorimplantable defibrillators (MeSH)injury (wounds and injuries) (MeSH)motor vehicle crashtraffic crashes (traffic accident) (MeSH)transport injurytrauma

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Area of Science:

  • Cardiology
  • Traffic Safety
  • Public Health

Background:

  • Implantable cardioverter-defibrillators (ICDs) are commonly implanted.
  • Individuals often reduce driving after ICD implantation, affecting crash risk assessments.
  • Real-world driving exposure data post-ICD is scarce.

Purpose of the Study:

  • To quantify road exposure changes after ICD implantation.
  • To calculate exposure-adjusted crash risks for ICD recipients.
  • To inform the interpretation of driving safety and crash risks post-ICD.

Main Methods:

  • Utilized 18 years of population-based health and driving data from British Columbia, Canada.
  • Estimated monthly road exposure relative to baseline (RERB) using clinical data and published adherence rates.
  • Calculated exposure-adjusted crash risks by comparing ICD recipients to matched controls.

Main Results:

  • Primary prevention ICD recipients showed a mean RERB of 0.29 in the first month; adjusted crash rate was not significantly different but sensitivity analyses suggested a ~5-fold higher risk with lower RERB.
  • Secondary prevention ICD recipients had a mean RERB of 0.50 in the first 6 months; adjusted crash rate was not significantly different, but sensitivity analyses indicated a ~2-fold higher risk in the first 3 months with lower RERB.
  • Substantial transient reductions in road exposure were observed across both groups.

Conclusions:

  • Transient reductions in driving exposure after ICD implantation significantly influence monthly crash risk interpretation.
  • Accurate assessment of driving behavior is essential for evaluating post-ICD safety.
  • Findings highlight the need to consider reduced road exposure when analyzing crash data for ICD patients.