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Abstract
Background Limited empirical evidence informs driving restrictions after implantable cardioverter-defibrillator (ICD) implantation. We sought to evaluate real-world motor vehicle crash risks after ICD implantation.
Methods We performed a retrospective cohort study using 22 years of population-based health and driving data from British Columbia, Canada (2019 population: 5 million). Individuals with a first ICD implantation between 1997 and 2019 were age and sex matched to three controls. The primary outcome was involvement as a driver in a crash that was attended by police or that resulted in an insurance claim. We used survival analysis to compare crash risk in the first 6 months after ICD implantation to crash risk during a corresponding 6-month interval among controls.
Results A crash occurred prior to a censoring event for 296 of 9373 individuals with ICDs and for 1077 of 28 119 controls, suggesting ICD implantation was associated with a reduced risk of subsequent crash (crude incidence rate, 8.5 vs 10.5 crashes per 100 person-years; adjusted HR (aHR), 0.71; 95% CI 0.61 to 0.83; p<0.001). Results were similar after stratification by primary versus secondary prevention ICD. Relative to controls, ICD patients had more traffic contraventions in the 3 years prior to ICD implantation but fewer contraventions in the 6 months after implantation, suggesting individuals reduced their road exposure (hours or miles driven per week) or drove more conservatively after ICD implantation.
Conclusions Crash risk is lower in the 6 months after ICD implantation than among matched controls, likely because individuals reduced their road exposure in order to comply with contemporary postimplantation driving restrictions. Policymakers might consider liberalisation of postimplantation driving restrictions while monitoring crash rates.
- Defibrillators, Implantable
- Cardiovascular Diseases
- Cohort Studies
- Epidemiology
Data availability statement
Data may be obtained from a third party and are not publicly available. Access to data provided by the Data Stewards is subject to approval, but can be requested for research projects through the Data Stewards or their designated service providers. All inferences, opinions and conclusions drawn are those of the authors and do not reflect the opinions or policies of the Data Stewards.
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Data availability statement
Data may be obtained from a third party and are not publicly available. Access to data provided by the Data Stewards is subject to approval, but can be requested for research projects through the Data Stewards or their designated service providers. All inferences, opinions and conclusions drawn are those of the authors and do not reflect the opinions or policies of the Data Stewards.
Footnotes
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Contributors JAS, SE, HC and JRB were responsible for initial study concept. All authors contributed to study design. JAS was responsible for acquisition of the data. DD-G had full access to all study data and was responsible for the integrity of the data and the accuracy of the data analysis. JAS, MK and IR were responsible for drafting the manuscript. All authors were responsible for critical revision of the manuscript and the decision to submit for publication. JAS is the corresponding senior author and guarantor.
Funding This study was supported by the Heart and Stroke Foundation of Canada (grant number: G-19-0026232). JAS was supported by a Mentored Clinician Scientist Award from the Vancouver Coastal Health Research Institute and a Health Professional-Investigator Award from Michael Smith Health Research BC. JRB was supported by Michael Smith Health Research BC and the British Columbia Emergency Medicine Network.
Disclaimer Funding organisations were not involved in the design and conduct of the study; collection, management, analysis and interpretation of the data; or preparation, review and approval of this manuscript.
Competing interests None declared.
Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.
Provenance and peer review Not commissioned; externally peer reviewed.
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