對心律不整患者的駕駛禁制令是為不當

心室心律不整病患不會導致更多意外發生

  雖然在某些州,對同意心律不整患者的駕駛權審核有特定的指標,然而,一份在八月九日The New England Journal of Medicine的研究報告建議,這些限制標準需要再審慎考量。研究人員發現,雖然病患的確可能再駕駛時發生心律不整的症狀,然而,實際上他們發生意外事故的機率是比一般人低。

Driving Restrictions on Arrhythmia Patients May Be Unwarranted

Ventricular Arrhythmias Don't Lead to More Accidents

By Aman Shah, MD
WebMD Medical News

Reviewed by Michael W. Smith, MD

Aug. 8, 2001 -- Although some states have specific guidelines for granting driving privileges to patients with cardiac arrhythmias, a report in the Aug. 9 issue of The New England Journal of Medicine suggests that this needs to be revisited. Researchers found that although patients do suffer from possible arrhythmia symptoms while driving, they actually have a lower accident rate than the general population.

"When we looked for evidence justifying these driving prohibitions, we were not able to find it," co-author L. Brent Mitchell, MD, tells WebMD. "We are not suggesting that physicians tell their patients to ignore these guidelines or that patients ignore the advice of their doctors. But we definitely believe that all guidelines and legal restrictions need to be revisited." Mitchell is professor and head of the division of cardiology at the Foothills Hospital of the University of Calgary.

The U.S. and Canadian researchers surveyed approximately 758 patients, who were part of an earlier trial comparing implantable defibrillators to antiarrhythmia therapy. Of these, 57% reported that they started driving within 3 months of their near-fatal ventricular tachyarrhythmia episode. By 6 months, 78% had resumed driving, and by 1 year, 88% were back on the road.

The patients reported a high rate of arrhythmia-related symptoms; 22% reported driving while having palpitations or dizziness, 11% had palpitations/dizziness that required them to stop the vehicle, and 2% had syncope. Of the patients with an implanted defibrillator, 8% reported receiving a shock while driving.

These numbers did not, however, translate into a high accident rate. Approximately 9% of those surveyed acknowledged having had an accident during a mean follow-up period of 35 months, but the accidents were preceded by symptoms of possible arrhythmia in only 11%. The overall accident rate of 55 accidents in 1,619 patient-years (3.4% per patient year) was lower than the annual incidence rate of 7.1% per year in the U.S., report the researchers.

However, Mitchell does point out that while many patients are ignoring guidelines, some are doing so at their own risk with regard to the law and insurers. "Most insurers will take the position that they should not be driving, and they may not be covered if something happens," he says.

Timothy W. Smith, MD, PhD, of the Washington University School of Medicine in St. Louis, says limitations of the newly published study prevent it from being the definitive word on whether patients who are newly treated for heart arrhythmias should drive. Smith wrote an editorial accompanying the study.

"I don't think that this study in and of itself is strong enough to recommend that patients and their doctors ignore established guidelines," Smith tells WebMD. "In some cases, the data are so strong that it makes sense to reject such guidelines, but this is not the case with this study."

"We do not suggest that physicians tell patients to ignore these prohibitions," says Mitchell. "Physicians are bound by the guidelines created by their own representatives and by the regulations made by driving administrators. We can't counsel that physicians should not follow those."

"The take-home message is that these guidelines need to be revisited, and that physicians can provide the leadership in that area," he adds.

With reporting by Salynn Boyles

© 2001 WebMD Corporation. All rights reserved.

    
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