Low fear, high fallout: employment-centred lessons from ICD driving restrictions

This Correspondence paper is linked to article Hansen MH, Rasmussen TB, Risom SS, et al. ‘Driving restrictions following defibrillator implantation: a nationwide register-linked survey study on the impact on employment, daily living, and driving behaviour’. Eur Heart J Qual Care Clin Outcomes 2025;11:889-899. https://doi.org/10.1093/ehjqcco/qcae071 Hansen et al.1 quantify an under-recognized trade-off of post-implant driving restrictions in implantable cardioverter-defibrillator (ICD) recipients: perceived driving-related fear is uncommon, yet the socioeconomic and functional fallout is substantial. In their nationwide register-linked survey, 33% of active professional drivers reported job loss attributable to the permanent professional-driving ban, and 47% of employed patients reported difficulty maintaining employment during private driving restrictions; among those restricted for ≥1 month, 26% described a substantial impediment to daily living. These findings remind us that ‘no driving’ is not only a safety directive but also a time-limited mobility disability that warrants anticipatory planning and structured support. Importantly, driving restrictions are typically anchored in traffic and licensing legislation (with variation across jurisdictions) rather than in individualized medical orders. Clinicians therefore cannot simply adjust restrictions at will, but we can operationalize support around them. We propose embedding a brief mobility-and-work impact screen both pre-implant and at discharge (professional-driving status, essential commuting, baseline weekly driving exposure, household driving alternatives, and access to public transport). A positive screen should trigger standardized interventions: a written restriction timeline with a clear reassessment date; telehealth or consolidated visits to reduce travel burden; standardized documentation for employers and insurers; and a proactive check-in within 7 days to address adherence barriers and mitigate missed follow-up or rehabilitation.