Reduced Physical Fitness in Patients With Heart Failure as a Possible Risk Factor for Impaired Driving Performance

Abstract

OBJECTIVE. Reduced physical fitness secondary to heart failure (HF) may contribute to poor driving; reduced physical fitness is a known correlate of cognitive impairment and has been associated with decreased independence in driving. No study has examined the associations among physical fitness, cognition, and driving performance in people with HF.METHOD. Eighteen people with HF completed a physical fitness assessment, a cognitive test battery, and a validated driving simulator scenario.RESULTS. Partial correlations showed that poorer physical fitness was correlated with more collisions and stop signs missed and lower scores on a composite score of attention, executive function, and psychomotor speed. Cognitive dysfunction predicted reduced driving simulation performance.CONCLUSION. Reduced physical fitness in participants with HF was associated with worse simulated driving, possibly because of cognitive dysfunction. Larger studies using on-road testing are needed to confirm our findings and identify clinical interventions to maximize safe driving.

Cardiorespiratory Fitness Mediates Cognitive Performance in Chronic Heart Failure Patients and Heart Transplant Recipients

“…Our study demonstrated that cardiorespiratory fitness ( O 2peak ) and O 2 at first ventilatory threshold correlated and fully mediated the relationship with processing speed and executive function performance, but not with verbal memory scores. It is well described in the literature that cardiorespiratory fitness is related to performances in global cognition, executive function, processing speed, attention and driving performance in HF patients [ 15 , 22 , 27 , 47 ], as well as with white matter structure in elderly adults [ 48 ]. This association is mediated, in part, by increases in brain perfusion and the ability of cerebral blood vessels to respond to demand [ 7 ].…”

“…Moreover, in coronary heart disease (CHD) patients, we also showed that cognitive performance was related to O 2peak , CO peak and reduced cerebral oxygenation/perfusion [ 19 ]. In HT and HF patients, daily physical activity and/or functional capacity are related to cognitive performance [ 20 , 21 , 22 , 23 ]. Therefore, O 2peak , VT 1 and CO peak , reflecting cardiorespiratory fitness and functional capacity, could be important contributors/mediators of cognitive performance in these cardiac patients (HF–HT).…”

Age-Related Diseases and Driving Safety

“…A Canadian autopsy study found that 86% of the drivers above 60 years who died at the wheel had coronary heart disease and 40% of these drivers showed abnormal driving behavior before the accident due to loss of control [160]. To be fit to drive, patients with CHD have to be in a stable state in which the risk of sudden worsening is very low [161]. Some of the patients with CHD experience seizure pain (angina pectoris).…”

A Systematic Review Examining Associations between Cardiovascular Conditions and Driving Outcomes among Older Drivers

“…Across three driving simulator studies, Alosco and colleagues (2013, 2015a, 2015b) found that older adults with heart failure (n = 18) had (1) poorer performance on attention/executive function tests and simulated driving compared to younger adults [35], (2) more WMH and reduced whole brain volume were associated with poor driving performance [36] and (3) decreased physical fitness was associated with poor driving performance [37]. During the simulation scenarios, collisions and missed stop signs were consistent markers of impaired driving performance.…”