2.3 Medical standards for licensing
From 22 June 2022 there have been changes to the fitness to drive criteria for the following conditions:
- Implantable cardioverter defibrillator (commercial vehicle drivers)
- Ventricular assist devices (private vehicle drivers)
- Congenital disorders (private and commercial vehicle drivers)
See Summary of changes and download the fact sheet for more details
2.3.1 Medical criteria
Requirements for unconditional and conditional licences are outlined in the following tables. Health professionals should familiarise themselves with the information in this chapter and the tabulated standards before assessing a person’s fitness to drive.
The standards for medical conditions in the tables below cover:
2.3.2 Conditional licences and periodic review
Because many cardiac conditions are stabilised and not cured, periodic review is recommended. In general, the review interval should be a minimum of 12 months unless otherwise recommended by the treating doctor/specialist, taking into consideration the licence type (e.g. commercial versus private vehicle), other health risk factors and how well the underlying illness is managed.
Where a condition has been effectively treated and there is minimal risk of recurrence, the driver may apply for reinstatement of an unconditional licence on the advice of the treating doctor or specialist (in the case of a commercial vehicle driver). Refer to Part A section 4.5. Reinstatement of licences or removal or variation of licence conditions.
Medical standards for licensing – cardiovascular conditions Health professionals should familiarise themselves with the information in this chapter and the tabulated standards before assessing a person’s fitness to drive. | ||
|---|---|---|
| Condition | Private standards (Drivers of cars, light rigid vehicles or motorcycles unless carrying public passengers or requiring a dangerous goods driver licence – refer to definition in Table 3) | Commercial standards (Drivers of heavy vehicles, public passenger vehicles or requiring a dangerous goods driver licence – refer to definition in Table 3) |
| Ischaemic heart disease | ||
Acute myocardial infarction (AMI) Refer also to coronary artery bypass grafting and to percutaneous coronary intervention. | Private standards The person should not drive for at least 2 weeks after an AMI. A person is not fit to hold an unconditional licence:
A conditional licence may be considered by the driver licensing authority subject to periodic review, taking into account the nature of the driving task and information provided by the treating doctor as to whether the following criteria are met:
Fitness thereafter should be assessed in terms of general convalescence. | Commercial standards The person should not drive for at least 4 weeks after an AMI. A person is not fit to hold an unconditional licence:
A conditional licence may be considered by the driver licensing authority subject to annual review, taking into account the nature of the driving task and information provided by the treating specialist as to whether the following criteria are met:
|
| Angina | Private standards A person with angina, which is usually absent on mild exertion, and who is compliant with treatment may drive without licence restriction and without notification to the driver licensing authority, subject to periodic monitoring. A person is not fit to hold an unconditional licence:
A conditional licence may be considered by the driver licensing authority subject to periodic review, taking into account the nature of the driving task and information provided by the treating specialist as to whether the following criteria are met:
| Commercial standards A person is not fit to hold an unconditional licence:
A conditional licence may be considered by the driver licensing authority subject to annual review, taking into account the nature of the driving task and information provided by the treating specialist as to whether the following criteria are met:
If myocardial ischaemia is demonstrated, a coronary angiogram may be offered. A conditional licence may be considered, subject to annual review, if the following criterion is met:
If the result of the angiogram shows a lumen diameter reduction of ≥ 70% in a major coronary branch and < 50% in the left main coronary artery (or if an angiogram is not conducted), a conditional licence may be considered, subject to annual review, if the following criteria are met:
The above criteria also apply if an angiogram is not conducted. Where surgery or percutaneous coronary intervention is undertaken to relieve the angina, the requirements listed in the table apply. |
| Coronary artery bypass grafting (CABG) | Private standards The person should not drive for at least 4 weeks after CABG. A person is not fit to hold an unconditional licence:
A conditional licence may be considered by the driver licensing authority subject to periodic review, taking into account the nature of the driving task and information provided by the treating doctor as to whether the following criteria are met:
| Commercial standards The person should not drive for at least 3 months after CABG. A person is not fit to hold an unconditional licence:
A conditional licence may be considered by the driver licensing authority subject to annual review, taking into account the nature of the driving task and information provided by the treating specialist as to whether the following criteria are met:
|
Percutaneous coronary intervention (PCI) (e.g. angioplasty/ stent) | Private standards The person should not drive for at least 2 days after the PCI. A person is not fit to hold an unconditional licence:
A conditional licence may be considered by the driver licensing authority subject to periodic review, taking into account the nature of the driving task and information provided by the treating doctor as to whether the following criteria are met:
| Commercial standards The person should not drive for at least 4 weeks after the PCI. A person is not fit to hold an unconditional licence:
A conditional licence may be considered by the driver licensing authority subject to annual review, taking into account the nature of the driving task and information provided by the treating specialist as to whether the following criteria are met:
|
| Disorders of rate, rhythm and conduction | ||
| Atrial fibrillation | Private standards The non-driving period will depend on the method of treatment – see below. A person is not fit to hold an unconditional licence:
A conditional licence may be considered by the driver licensing authority subject to periodic review, taking into account the nature of the driving task and information provided by the treating doctor as to whether the following criteria are met:
The person should not drive for:
| Commercial standards The non-driving period will depend on the method of treatment – see below. A person is not fit to hold an unconditional licence:
A conditional licence may be considered by the driver licensing authority subject to annual review, taking into account the nature of the driving task and information provided by the treating specialist as to whether the following criteria are met:
The person should not drive for:
If the person is taking anticoagulants refer to ‘anticoagulant therapy’. |
Paroxysmal arrhythmias (e.g. supraventricular tachycardia, atrial flutter, idiopathic ventricular tachycardia) | Private standards A person is not fit to hold an unconditional licence:
A conditional licence may be considered by the driver licensing authority subject to periodic review,* taking into account the nature of the driving task and information provided by the treating doctor as to whether the following criteria are met:
* Where the condition is considered to be cured, the requirement for periodic review may be waived. | Commercial standards The non-driving period is at least 4 weeks. A person is not fit to hold an unconditional licence:
A conditional licence may be considered by the driver licensing authority subject to periodic review,* taking into account the nature of the driving task and information provided by the treating specialist as to whether the following criteria are met:
The person should not drive for:
* Where the condition is considered to be cured, the requirement for periodic review may be waived. |
| Cardiac arrest | Private standards The person should not drive for at least 6 months following a cardiac arrest. Limited exceptions apply – see below.* A person is not fit to hold an unconditional licence:
A conditional licence may be considered by the driver licensing authority subject to periodic review, taking into account the nature of the driving task and information provided by the treating doctor as to whether the following criteria are met:
* A shorter non-driving period may be considered subject to specialist assessment if the cardiac arrest has occurred within 48 hours of an acute myocardial infarction, or if the arrhythmia causing the cardiac arrest has been addressed by radio frequency ablation surgery or by pacemaker implantation. | Commercial standards The person should not drive for at least 6 months following a cardiac arrest. A person is not fit to hold an unconditional licence:
A conditional licence may be considered by the driver licensing authority subject to annual review, taking into account the nature of the driving task and information provided by the treating specialist as to whether the following criteria are met:
|
Cardiac pacemaker Refer also to ‘implantable cardioverter defibrillator’ if appropriate. | Private standards The person should not drive for at least 2 weeks after a pacemaker is inserted. A person is not fit to hold an unconditional licence:
A conditional licence may be considered by the driver licensing authority subject to periodic review, taking into account the nature of the driving task and information provided by the treating doctor as to whether the following criteria are met:
| Commercial standards The person should not drive for at least 4 weeks after a pacemaker is inserted. A person is not fit to hold an unconditional licence:
A conditional licence may be considered by the driver licensing authority subject to annual review, taking into account the nature of the driving task and information provided by the treating specialist as to whether the following criteria are met:
|
| Implantable cardioverter defibrillator (ICD) | Private standards The non-driving period will depend on the reason for ICD implantation – see below. A person is not fit to hold an unconditional licence:
A conditional licence may be considered by the driver licensing authority subject to periodic review, taking into account the nature of the driving task and information provided by the treating specialist as to whether the following criteria are met:
A person should not drive:
| Commercial standards The person should not drive for at least 6 months after the ICD is implanted. A person is not fit to hold an unconditional licence or a conditional licence:
A conditional licence may be considered by the driver licensing authority subject to annual review, taking into account the nature of the driving tasks and information provided by the treating specialist* as to whether the following criteria are met:
* The initial assessment is to be performed by the treating electrophysiologist. |
ECG changes Strain patterns, bundle branch blocks, heart block, etc. Refer also to ‘cardiac pacemaker’. | Private standards The person should not drive for at least 2 weeks following initiation of treatment. A person is not fit to hold an unconditional licence:
A conditional licence may be considered by the driver licensing authority subject to periodic review, taking into account the nature of the driving task and information provided by the treating doctor as to whether the following criteria are met:
* Where the condition is considered to be cured, the requirement for periodic review may be waived. | Commercial standards The person should not drive for at least 3 months following initiation of treatment. A person is not fit to hold an unconditional licence:
A conditional licence may be considered by the driver licensing authority subject to annual review, taking into account the nature of the driving task and information provided by the treating specialist as to whether the following criteria are met:
* Where the condition is considered to be cured, the requirement for periodic review may be waived. |
| Vascular disease | ||
Aneurysms – abdominal and thoracic | Private standards The person should not drive for at least 4 weeks after repair. A person is not fit to hold an unconditional licence:
A conditional licence may be considered by the driver licensing authority subject to periodic review, taking into account the nature of the driving task and information provided by the treating specialist as to whether the following criteria are met:
| Commercial standards The person should not drive for at least 3 months after repair. A person is not fit to hold an unconditional licence:
A conditional licence may be considered by the driver licensing authority subject to annual review, taking into account the nature of the driving task and information provided by the treating specialist as to whether the following criteria are met:
|
| Deep vein thrombosis (DVT) | Private standards There are no licensing criteria for DVT. For advisory non-driving period following DVT refer to Table 5. Suggested non-driving periods after cardiovascular events or procedures. For long-term anticoagulation refer to Table 5. Suggested non-driving periods after cardiovascular events or procedures. Refer also to section 2.2.8 in the text. | Commercial standards There are no licensing criteria for DVT. For advisory non-driving period following DVT refer to Table 5. Suggested non-driving periods after cardiovascular events or procedures. For long-term anticoagulation refer to Table 5. Suggested non-driving periods after cardiovascular events or procedures. Refer also to section 2.2.8 in the text. |
| Pulmonary embolism (PE) | Private standards There are no licensing criteria for PE. For advisory non-driving period following PE refer to Table 5. Suggested non-driving periods after cardiovascular events or procedures. For long-term anticoagulation refer to Table 5. Suggested non-driving periods after cardiovascular events or procedures. Refer also to section 2.2.8. | Commercial standards There are no licensing criteria for PE. For advisory non-driving period following PE refer to Table 5. Suggested non-driving periods after cardiovascular events or procedures. For long-term anticoagulation refer to Table 5. Suggested non-driving periods after cardiovascular events or procedures. Refer also to section 2.2.8. |
Valvular heart disease (including treatment with MitraClips, tricuspid clips, transcutaneous aortic valve replacement and transcutaneous pulmonary valve replacement) | Private standards The person should not drive for at least 4 weeks following valve repair. A person is not fit to hold an unconditional licence:
A conditional licence may be considered by the driver licensing authority subject to periodic review, taking into account the nature of the driving task and information provided by the treating doctor as to whether the following criteria are met:
| Commercial standards The person should not drive for at least 4 weeks following valve repair. A person is not fit to hold an unconditional licence:
A conditional licence may be considered by the driver licensing authority subject to annual review, taking into account the nature of the driving task and information provided by the treating specialist as to whether the following criteria are met:
|
| Other cardiovascular diseases | ||
| Anticoagulant therapy | Private standards A person on a private vehicle licence may drive without restriction and without reporting to the driver licensing authority, pending periodic review, if:
| Commercial standards A person is not fit to hold an unconditional licence:
A conditional licence may be considered by the driver licensing authority subject to annual review, taking into account the nature of the driving task and information provided by the treating specialist as to whether the following criterion is met:
|
Congenital disorders Refer also to ‘heart failure’, ‘atrial fibrillation’, ‘paroxysmal arrhythmias’, ‘cardiac pacemaker’ and ‘ICD’. | Private standards A person may drive without restriction and without reporting to the driver licensing authority if they have uncomplicated congenital heart disease and there are no or minimal symptoms relevant to driving. A person should not drive for a period of at least 4 weeks after surgery to correct a congenital lesion. The person should not drive for at least 2 weeks following a
A person is not fit to hold an unconditional licence:
A conditional licence may be considered by the driver licensing authority subject to periodic review, taking into account the nature of the driving task and information provided by the treating specialist as to whether the following criterion is met:
| Commercial standards A person should not drive for at least 3 months following surgical treatment for congenital heart disease. A person should not drive for 4 weeks following a percutaneous intervention for congenital heart disease. A person is not fit to hold an unconditional licence:
A conditional licence may be considered by the driver licensing authority subject to annual review taking into account the nature of the driving task and the information provided by the treating specialist as to whether the following criteria are met:
|
| Dilated cardiomyopathy | Private standards A person is not fit to hold an unconditional licence:
A conditional licence may be considered by the driver licensing authority subject to periodic review, taking into account the nature of the driving task and information provided by the treating doctor as to whether the following criteria are met:
Cardiologist assessment is recommended for complex presentations. | Commercial standards A person is not fit to hold and unconditional licence:
A conditional licence may be considered by the driver licensing authority subject to annual review, taking into account the nature of the driving task and information provided by the treating specialist as to whether the following criteria are met:
|
| Hypertrophic cardiomyopathy (HCM) | Private standards A person is not fit to hold an unconditional licence:
A conditional licence may be considered by the driver licensing authority subject to periodic review, taking into account the nature of the driving task and information provided by the treating specialist as to whether the following criteria are met:
| Commercial standards A person is not fit to hold an unconditional licence:
A conditional licence may be considered by the driver licensing authority subject to annual review, taking into account the nature of the driving task and information provided by the treating specialist as to whether the following criteria are met:
|
Heart failure Refer also to ‘ventricular assist devices’. | Private standards A person is not fit to hold an unconditional licence:
A conditional licence may be considered by the driver licensing authority subject to periodic review, taking into account the nature of the driving task and information provided by the treating doctor as to whether the following criteria are met:
| Commercial standards A person is not fit to hold an unconditional licence:
A conditional licence may be considered by the driver licensing authority subject to annual review, taking into account the nature of the driving task and information provided by the treating specialist as to whether the following criteria are met:
|
| Heart transplant | Private standards The person should not drive for at least 6 weeks post transplant. A person is not fit to hold an unconditional licence:
A conditional licence may be considered by the driver licensing authority subject to periodic review, taking into account the nature of the driving task and information provided by the treating specialist as to whether the following criteria are met:
| Commercial standards The person should not drive for at least 3 months post transplant. A person is not fit to hold an unconditional licence:
A conditional licence may be considered by the driver licensing authority subject to annual review, taking into account the nature of the driving task and information provided by the treating specialist as to whether the following criteria are met:
|
| Ventricular assist devices (LVAD, BiVAD) | Private standards A person should not drive for at least 3 months following insertion of a ventricular assist device. A person is not fit to hold an unconditional licence:
A conditional licence may be considered by the driver licensing authority subject to 6-monthly review, taking into account the nature of the driving task and information provided by the treating specialist as to whether the following criteria are met:
Where there is concern of cognitive or neurological impairment, a practical driver assessment should be conducted (refer to Part A section 2.3.1. Practical driver assessments). | Commercial standards A person is not fit to hold an unconditional licence or a conditional licence:
|
| Hypertension | Private standards A person is not fit to hold an unconditional licence:
A conditional licence may be considered by the driver licensing authority subject to periodic review, taking into account the nature of the driving task and information provided by the treating doctor as to whether the following criteria are met:
| Commercial standards A person is not fit to hold an unconditional licence:
A conditional licence may be considered by the driver licensing authority subject to annual review, taking into account the nature of the driving task and information provided by the treating specialist* as to whether the following criteria are met:
* Ongoing fitness to drive for commercial vehicle drivers may be assessed by the treating GP provided this is mutually agreed by the specialist, GP and driver licensing authority. The initial granting of a conditional licence must, however, be based on information provided by the specialist. |
| Stroke | Private standards Refer to section 6. Neurological conditions. | Commercial standards Refer to section 6. Neurological conditions. |
Syncope Refer also to section 1. Blackouts. | Private standards The person can resume driving within 24 hours if the episode was vasovagal in nature with a clear-cut precipitating factor (e.g. venesection) and the situation is unlikely to occur while driving. The driver licensing authority should not be notified. The person should not drive for at least 4 weeks after syncope due to other cardiovascular causes. A person is not fit to hold an unconditional licence:
A conditional licence may be considered by the driver licensing authority subject to periodic review, taking into account the nature of the driving task and information provided by the treating doctor as to whether the following criteria are met:
| Commercial standards The person can resume driving within 24 hours if the episode was vasovagal in nature with a clear-cut precipitating factor (e.g. venesection) and the situation is unlikely to occur while driving. The driver licensing authority should not be notified. The person should not drive for at least 3 months after syncope due to other cardiovascular causes. A person is not fit to hold an unconditional licence:
A conditional licence may be considered by the driver licensing authority subject to annual review, taking into account the nature of the driving task and information provided by the treating specialist as to whether the following criteria are met:
|
IMPORTANT: The medical standards and management guidelines contained in this chapter should be read in conjunction with the general information contained in Part A of this publication. Practitioners should give consideration to the following:
Licensing responsibility
The responsibility for issuing, renewing, suspending or cancelling a person’s driver licence (including a conditional licence) lies ultimately with the driver licensing authority. Licensing decisions are based on a full consideration of relevant factors relating to health and driving performance.
Conditional licences
For a conditional licence to be issued, the health professional must provide to the driver licensing authority details of the medical criteria not met, evidence of the medical criteria met, as well as the proposed conditions and monitoring requirements. The presence of other medical conditions While a person may meet individual disease criteria, concurrent medical conditions may combine to affect fitness to drive – for example, hearing, visual or cognitive impairment (refer to Part A section 2.2.7. Older drivers and age-related changes and section 2.2.8. Multiple medical conditions).
The nature of the driving task
The driver licensing authority will take into consideration the nature of the driving task as well as the medical condition, particularly when granting a conditional licence. For example, the licence status of a farmer requiring a commercial vehicle licence for the occasional use of a heavy vehicle may be quite different from that of an interstate multiple combination vehicle driver. The examining health professional should bear this in mind when examining a person and when providing advice to the driver licensing authority.
Reporting responsibilities
Patients should be made aware of the effects of their condition on driving and should be advised of their legal obligation to notify the driver licensing authority where driving is likely to be affected. The health professional may themselves advise the driver licensing authority as the situation requires (refer to section 3.3 and step 6).
References and further reading
- Charlton, J. L. & Monash University Accident Research Centre. Influence of chronic illness on crash involvement of motor vehicle drivers. (Monash University, Accident Research Centre, 2010).
- Chee, J. N. et al. A systematic review of the risk of motor vehicle collision in patients with syncope. Canadian Journal of Cardiology 37, 151–161 (2021).
- European Working Group on Driving and Cardiovascular Disease. New standards for driving and cardiovascular diseases. (2013).
- Canadian Medical Association. CMA driver’s guide: determining medical fitness to operate motor vehicles. (Joule, 2017).
- Atherton, J. J. et al. National Heart Foundation of Australia and Cardiac Society of Australia and New Zealand: guidelines for the prevention, detection, and management of heart failure in Australia 2018. Heart Lung and Circulation 27, 1123–1208 (2018).
- Lovibond, S. W., Odell, M. & Mariani, J. A. Driving with cardiac devices in Australia. Does a review of recent evidence prompt a change in guidelines? Internal Medicine Journal 50, 271–277 (2020).
- Watanabe, E., Abe, H. & Watanabe, S. Driving restrictions in patients with implantable cardioverter defibrillators and pacemakers. Journal of Arrhythmia 33, 594–601 (2017).
- Boodhwani, M. et al. Canadian Cardiovascular Society position statement on the management of thoracic aortic disease. Canadian Journal of Cardiology 30, 577–589 (2014).
- Tan, V. H., Ritchie, D., Maxey, C. & Sheldon, R. Prospective assessment of the risk of vasovagal syncope during driving. JACC: Clinical Electrophysiology 2, 203–208 (2016).
- Shen, W. K. et al. 2017 ACC/AHA/ HRS guideline for the evaluation and management of patients with syncope: a report of the American College of Cardiology/American Heart Association task force on clinical practice guidelines and the Heart Rhythm Society. Circulation 136, e60– e122 (2017).
- Moya, A. et al. Guidelines for the diagnosis and management of syncope (version 2009). European Heart Journal 30, 2631– 2671 (2009).
- Hanke, J. S. et al. Driving after left ventricular assist device implantation. Artificial Organs 42, 695–699 (2018).
- Slaughter, M. S. et al. Advanced heart failure treated with continuous-flow left ventricular assist device. New England Journal of Medicine 361, 2241–2251 (2009).
- Singhvi, A. & Trachtenberg, B. Left ventricular assist devices 101: shared care for general cardiologists and primary care. Journal of Clinical Medicine 8, 1720 (2019).