Driving Pulseless: A Driving Survey of LVAD Patients and Their Providers

Abstract

Background With the introduction of the Left Ventricular Assist Device (LVAD), a new population of advanced heart failure patients are now raising unique questions for the medical community. In particular, the limitations and safety of driving with an LVAD. There is limited data on the driving patterns or safety of driving in these patients, as well as a lack of expert consensus recommendations on the topic. Objectives The purpose of this study was to further understand the driving practices of our center's LVAD population, as well as our expert providers’ awareness of state and institutional recommendations on the subject. Methods This study was a cross sectional, paper based survey of our ambulatory LVAD population. It was conducted at the University of Rochester Medical Center during a 6 month period from February 2017 to August 2017. A total of 124 participants, who were at least 3 months post HeartMate II LVAD implantation and presented to their outpatient clinic appointment, were surveyed. Demographics, driving practices before and after implant, and frequency of alarms while driving were collected. A total of 15 advanced Heart Failure providers were also surveyed regarding their knowledge of New York State laws regarding driving with a LVAD, knowledge of their institutional policy, and their personal opinions about LVAD patients and driving. Results A total of 86 surveys (69%) were returned. Before LVAD implantation 90% were driving, and 61% reported they were the primary driver for their household. After LVAD implant 77% reported they resumed driving, 35% less than 3 months after implant. Of the drivers, most reported driving 7 days a week, with an average of 112 miles/week. The most common reasons cited for driving were medical necessity and work. Eight patients reported experiencing LVAD alarms while driving which were related to low battery alerts. All were able to be safely addressed by pulling over, and none resulted in an accident. Of the 15 LVAD providers, thirteen (87%) completed the survey. The results showed that all correctly knew that there were no specific New York State laws regarding driving, but significant variability existed about the intuitional policy and personal provider recommendations. Only 62% reported they specifically address the issue of driving with their LVAD patients, but 100% of the respondents believed that LVAD patients should be allowed to drive. Conclusions The ability to drive can have a significant impact on a patient's independence and perceived quality of life. Our survey found that driving with an LVAD is fairly common and reasonably safe in the stable patient, but there continues to be a lack of expert consensus on the matter. Therefore, LVAD implant centers should be encouraged to establish clear policies for their expert providers. As medical providers, it is also critical that the subject of driving be addressed with all our LVAD patients.