Approach to assessing fitness to drive in patients with cardiac and cognitive conditions.

OBJECTIVE To help physicians become more comfortable assessing the fitness to drive of patients with complex cardiac and cognitive conditions. QUALITY OF EVIDENCE The approach described is based on the authors' clinical practices, recommendations from the Third Canadian Consensus Conference on Diagnosis and Treatment of Dementia, and guidelines from the 2003 Canadian Cardiovascular Society Consensus Conference. MAIN MESSAGE When assessing fitness to drive in patients with multiple, complex health problems, physicians should divide conditions that might affect driving into acute intermittent (ie, not usually present on examination) and chronic persistent (ie, always present on examination) medical conditions. Physicians should address acute intermittent conditions first, to allow time for recovery from chronic persistent features that might be reversible. Decisions regarding fitness to drive in acute intermittent disorders are based on probability of recurrence; decisions in chronic persistent disorders are based on functional assessment. CONCLUSION Assessing fitness to drive is challenging at the best of times. When patients have multiple comorbidities, assessment becomes even more difficult. This article provides clinicians with systematic approaches to work through such complex cases.