Cardiovascular disorders: assessing fitness to drive
Source: gov.uk (2025-11-07)

Advice for medical professionals to use when assessing drivers with cardiovascular disorders.

Angina - to include INOCA (ischaemia with non-obstructive arteries)

Acute coronary syndrome (ACS) - to include type 1 and type 2 myocardial infarction, MINOCA (myocardial infarction with non-obstructive coronary arteries) and Takotsubo cardiomyopathy

Elective percutaneous coronary intervention (PCI)

Coronary artery bypass graft (CABG)

Coronary artery disease

For Group 2 licensing, if there is evidence of obstructive coronary artery disease on invasive or CT angiography or myocardial ischaemia on functional testing but it does not fall under any of the categories above, those individuals would need to meet the functional test requirements.

Spontaneous coronary artery dissection (SCAD)

Transient loss of consciousness (‘blackouts’) – or lost or altered awareness – including blackouts with seizure markers and cough syncope

Refer to Appendix D. (https://www.gov.uk/guidance/appendices-assessing-fitness-to-drive#appendix-d-transient-loss-of-consciousness-blackouts-and-lost-or-altered-awareness)

Arrhythmias

Arrhythmias include:
- sinoatrial disease
- significant atrioventricular conduction defect
- atrial flutter or fibrillation
- narrow or broad complex tachycardia
If a transient arrhythmia occurs during an acute coronary syndrome, the guidance relating to ACS takes precedence.

Should a ventricular arrhythmia result in either a clinical indication or clinical recommendation for ICD implant, then a period of 6 months will be required off Group 1 driving (following the date of the last arrhythmic episode or the date of ICD implant). A Group 2 licence will be permanently revoked, even if implantation does not occur.

Pacemakers are considered separately.

Successful catheter ablation

Pacemaker implant – including box change

Congenital complete heart block

Implantable cardioverter defibrillator (ICD)

Group 1 car and motorcycle drivers

In all cases of ICD implanted for sustained ventricular arrhythmia associated with incapacity, driving must stop for 6 months from the date of ICD implantation and any resumption requires:
- the device being under regular review with interrogation
- no other disqualifying condition
- all the requirements as below being met
Group 2 bus and lorry drivers

ICD implantation is a permanent bar to Group 2 licensing. In all cases of ICD implantation (including prophylactic ICD implantation) driving must stop permanently and:
- DVLA must be notified
- the licence will be refused or revoked permanently
ICD implanted for sustained ventricular arrhythmia (secondary prevention)

For the purposes of this guidance ‘incapacity’ is defined as any condition, symptom or treatment that is likely to cause an individual to be unable to safely control or stop a vehicle.

Prophylactic ICD (primary prevention)

For Group 2 licensing, should ICD implantation be recommended (based upon clinical guidance or expert opinion), but implantation does not occur or is declined by the driver, then the driver or applicant will be assessed against the ICD standard. This means the licence will be refused or revoked permanently.

For the purposes of this guidance ‘incapacity’ is defined as any condition, symptom or treatment that is likely to cause an individual to be unable to safely control or stop a vehicle.

Aortic aneurysm – ascending or descending thoracic aorta (which includes the aortic arch) or abdominal

All patients must have regular medical review.

For Group 2 cases, the exercise or other functional test requirements will need to be met in all cases of aortic aneurysm involving either the descending thoracic aorta (which includes the aortic arch) or the abdominal aorta.

Aortic aneurysm (see separate standards for people with bicuspid aortopathy or Marfan syndrome)

*The exercise or other functional test requirements will need to be met in all cases of abdominal or descending thoracic or aortic arch aortic aneurysm.

Bicuspid aortopathy

Note: Assess risk factors for aortic dissection for all drivers with bicuspid aortopathy*

*Risk factors for dissection include:

Coarctation of aorta

Systemic hypertension

Family history of dissection

Documented increase in aortic diameter greater than 3mm/year

Aortic dissection

Note: ‘satisfactory control of blood pressure’ means clinically relevant to aortic dissection, not the DVLA standard for hypertension.

Marfan syndrome and other inherited aortopathies

Note: Assess risk factors for aortic dissection for all drivers with Marfan syndrome*

*Risk factors include:

Family history of aortic dissection

Severe aortic or mitral regurgitation

Greater than 3mm per year increase than aneurysm diameter

Pregnancy

Peripheral arterial disease

Hypertension

Cardiomyopathies

Note: DVLA bars Group 2 bus and lorry licensing when left ventricular ejection fraction is less than 40%.

Also refer to the following sections in this document:
- arrhythmia (https://www.gov.uk/guidance/cardiovascular-disorders-assessing-fitness-to-drive#arrhythmias)
- pacemaker implant (https://www.gov.uk/guidance/cardiovascular-disorders-assessing-fitness-to-drive#pacemaker-implant--including-box-change)
- implantable cardioverter defibrillator (https://www.gov.uk/guidance/cardiovascular-disorders-assessing-fitness-to-drive#implantable-cardioverter-defibrillator-icd)
- the European Society of Cardiology HCM Risk of Sudden Cardiac Death Calculator in Appendix C (https://www.gov.uk/guidance/appendices-assessing-fitness-to-drive#appendix-c-cardiovascular-considerations)
Hypertrophic cardiomyopathy (HCM)

*The ‘appropriate specialist’ must be a consultant cardiologist.

Arrhythmogenic right ventricular cardiomyopathy and allied disorders

Heart failure (including ischaemic cardiomyopathy and dilated cardiomyopathy)

Refer to NYHA classification detailed below.

New York Heart Association (NYHA) classification of heart failure

The New York Heart Association (NYHA) classification is used to grade the severity of functional limitations in a patient with heart failure (1):
- class I no limitation of physical activity – ordinary physical activity does not cause fatigue, breathlessness or palpitation (includes asymptomatic left ventricular dysfunction)
- class II slight limitation of physical activity – patients are comfortable at rest. Ordinary physical activity results in fatigue, palpitation, breathlessness or angina pectoris (symptomatically ‘mild’ heart failure)
- class III marked limitation of physical activity – although patients are comfortable at rest, less than ordinary activity will lead to symptoms (symptomatically ‘moderate’ heart failure)
- class IV inability to carry out any physical activity without discomfort – symptoms of congestive cardiac failure are present even at rest. Increased discomfort with any physical activity (symptomatically ‘severe’ heart failure)
Cardiac resynchronisation therapy (CRT)

Heart transplant – including heart and lung transplant

Pulmonary arterial hypertension (including chronic thromboembolic pulmonary hypertension) – an established diagnosis (under the care of a specialist centre)

Heart valve disease

Note:
- also refer to heart valve surgery (https://www.gov.uk/guidance/cardiovascular-disorders-assessing-fitness-to-drive#heart-valve-surgery--including-transcatheter-aortic-valve-implantation-and-other-cardiac-or-pulmonary-percutaneous-devices)
- separate standards for aortic stenosis, see below.
Aortic stenosis (to include sub-aortic and supra-aortic stenosis)

See Appendix C (https://www.gov.uk/guidance/appendices-assessing-fitness-to-drive#appendix-c-cardiovascular-considerations) for the definition of ‘severe’ aortic stenosis.

Heart valve surgery – including percutaneous valve intervention

Congenital heart disease (CHD)

*See classification of congenital heart disease complexity (https://academic.oup.com/eurheartj/article/42/6/563/5898606?login=false#313715121) and the section in Appendix C (https://www.gov.uk/guidance/appendices-assessing-fitness-to-drive#appendix-c-cardiovascular-considerations).

For syncope, refer to Appendix D. (https://www.gov.uk/guidance/appendices-assessing-fitness-to-drive#appendix-d-transient-loss-of-consciousness-blackouts-and-lost-or-altered-awareness)

ECG abnormality – suspected myocardial infarction

Left bundle branch block

Pre-excitation

Long QT syndrome

* corrected QT interval

Brugada syndrome found by an ECG (Type 1 pattern)

Brugada ECG (spontaneous or drug induced) without any associated symptoms

Brugada ECG (spontaneous or drug induced) with associated transient loss of consciousness (T-LOC) or arrhythmia

*An appropriate specialist is either a consultant electrophysiologist or a specialist in inherited cardiac conditions.

The report should address the risk of a further event (must be no more than 20% per annum for Group 1 licensing and no more than 2% per annum for Group 2 licensing).

Carotid artery stenosis