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Prospective Assessment of the Risk of Vasovagal Syncope During Driving
Open accessAbstract
Objectives This study sought to estimate the likelihood of a motor vehicle accident causing serious risk or harm in patients with frequent vasovagal syncope, and compare this with international accident data. Background Recurrent vasovagal syncope poses a risk because of fainting while driving, but prospective, benchmarked estimates of this risk have not been reported. Methods Data were from the POST (Prevention of Syncope Trial)-1 and -2, which were multicenter randomized studies of patients with ≥3 lifetime vasovagal syncope spells. POST-1 patients (reported in 2005) received metoprolol or placebo for ≤1 year between 1998 and 2004; POST 2 patients received fludrocortisone or placebo for ≤1 year between 2006 and 2011. Accident data were recovered from Internet reports from the United States, United Kingdom, and Canada. Results A total of 418 patients (age 38 ± 17 years) had a median of 10 lifetime faints and a median of 3 faints in the previous year. Total follow-up time was 323 years, or 0.77 years per person. A total of 174 subjects fainted, having a total of 615 faints. Two patients fainted while driving, without fatality or injury, with a likelihood of 0.62% per person-year. The risk of serious harm or death was <0.0035% per person-year, and 0.0018% per faint. In the general U.S., U.K., and Canadian driving populations, the risk of serious harm or death was 0.067% per driver-year, and the risk of death was 0.009%. Conclusions The estimated risk of serious harm or death was <0.0035% per person-year in highly symptomatic patients, less than the risk of serious harm or death in the general population. (A Randomized Clinical Trial of Fludrocortisone for Vasovagal Syncope: The Second Prevention of Syncope Trial [POST II]; NCT00118482).
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The 418 patients in POST I and POST II had a median of 3 vasovagal faints in 1 year but had no serious injuries or deaths and only 2 minor accidents in the subsequent year.
“The 418 patients in POST I and POST II had a median of 3 vasovagal faints in 1 year but had no serious injuries or deaths and only 2 minor accidents in the subsequent year (694).”
From 2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope (2017) · cites this paper as [694]
The Results report 418 POST-1 and POST-2 patients with a median of three faints in the previous year, followed for up to one year (323 person-years total). They report no injury or fatality from fainting while driving, but only one minor accident, not two. (LLM, conf=0.90)
Experimental — accuracy not yet measuredIn the general population, the yearly risk of serious injury and death is 0.067%, or 1 in 1,500.
“In the general population, the yearly risk of serious injury and death is 0.067%, or 1 in 1,500 (694).”
From 2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope (2017) · cites this paper as [694]
The Abstract and Discussion report an estimated 0.067% annual risk of serious injury or death in the general U.S., U.K., and Canadian driving populations. The claim gives the correct figure (approximately 1 in 1,500), but omits that it concerns motor vehicle accidents and is measured per driver-year, not across the general population for all causes. (LLM, conf=0.85)
Experimental — accuracy not yet measuredThe societally acceptable risk of injury and death due to motor vehicle accidents has been quantified from an analysis of accident data collected in the United States, United Kingdom, and Canada.
“The societally acceptable risk of injury and death due to motor vehicle accidents has been quantified from an analysis of accident data collected in the United States, United Kingdom, and Canada (694).”
From 2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope (2017) · cites this paper as [694]
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References 19 · Cited by 29
Research works printed but not linked: 18
- Moya, 2009, Guidelines for the diagnosis and management of syncope (version 2009): the Task Force for the Diagnosis and Management of Syncope of the European Society of Cardiology (ESC), Eur Heart J, 30, 2631, 10.1093/eurheartj/ehp298 · DOI · Paper page
- Saklani, 2013, Syncope, Circulation, 127, 1330, 10.1161/CIRCULATIONAHA.112.138396 · DOI
- Sorajja, 2009, Syncope while driving: clinical characteristics, causes, and prognosis, Circulation, 120, 928, 10.1161/CIRCULATIONAHA.108.827626 · DOI
- Beran, 2005, Analysis and overview of the guidelines for assessing fitness to drive for commercial and private vehicle drivers, Intern Med J, 35, 364, 10.1111/j.1445-5994.2005.00813.x · DOI
- Maas, 2003, Syncope, driving recommendations, and clinical reality: survey of patients, BMJ, 326, 21, 10.1136/bmj.326.7379.21 · DOI
- Sakaguchi, 2013, Syncope and driving, flying and vocational concerns, Prog Cardiovasc Dis, 55, 454, 10.1016/j.pcad.2012.11.010 · DOI
- Sorajja, 2010, Driving guidelines and restrictions in patients with a history of cardiac arrhythmias, syncope,or implantable devices, Curr Treat Options Cardiovasc Med, 12, 443, 10.1007/s11936-010-0088-3 · DOI
- Bhati, 1999, Driving safety among patients with neurocardiogenic (vasovagal) syncope, Pacing Clin Electrophysiol, 22, 1576, 10.1111/j.1540-8159.1999.tb00375.x · DOI
- Blitzer, 2003, Causes of impaired consciousness while driving a motorized vehicle, Am J Cardiol, 91, 1373, 10.1016/S0002-9149(03)00336-9 · DOI
- Folino, 2012, Syncope while driving: pathophysiological features and long-term follow-up, Auton Neurosci, 166, 60, 10.1016/j.autneu.2011.09.003 · DOI
- Li, 2000, Potential risk of vasovagal syncope for motor vehicle driving, Am J Cardiol, 85, 184, 10.1016/S0002-9149(99)00647-5 · DOI
- Simpson, 2004, Assessment of the cardiac patient for fitness to drive: drive subgroup executive summary, Can J Cardiol, 20, 1314
- Sheldon, 2006, Prevention of Syncope Trial (POST): a randomized, placebo-controlled study of metoprolol in the prevention of vasovagal syncope, Circulation, 113, 1164, 10.1161/CIRCULATIONAHA.105.535161 · DOI · Paper page
- Raj, 2006, The Second Prevention of Syncope Trial (POST II)–a randomized clinical trial of fludrocortisone for the prevention of neurally mediated syncope: rationale and study design, Am Heart J, 151, 1186.e11, 10.1016/j.ahj.2006.03.013 · DOI
- Sheldon, 2006, Diagnostic criteria for vasovagal syncope based on a quantitative history, Eur Heart J, 27, 344, 10.1093/eurheartj/ehi584 · DOI · Paper page
- Simpson, 2000, Impact of a mandatory physician reporting system for cardiac patients potentially unfit to drive, Can J Cardiol, 16, 1257
- Turnipseed, 2008, Reporting patterns for “lapses of consciousness” by California emergency physicians, J Emerg Med, 35, 15, 10.1016/j.jemermed.2007.06.035 · DOI
- Sheldon, 1995, Can patients with neuromediated syncope safely drive motor vehicles?, Am J Cardiol, 75, 955, 10.1016/S0002-9149(99)80699-7 · DOI
Metadata
- Authors
- Tan, V. H., Ritchie, D., Maxey, C., & Sheldon, R.
- Affiliations
- University of Calgary (CA)
- Corresponding author
- Sheldon, Robert
- Venue
- JACC: Clinical Electrophysiology
- Publisher
- Elsevier BV
- Published
- 2016-04
- Volume
- 2
- Issue
- 2
- Pages
- 203-208
- ISSN
- 2405-500X (ISSN-L)
- OpenAlex
- W2201472731
- Cited by
- 29
- References
- 19
- Citations by year
- 2026: 2 · 2025: 1 · 2023: 3 · 2022: 1 · 2021: 1 · 2020: 3 · 2018: 4 · 2017: 10 · 2016: 4
- FWCI
- 6.06
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- JACC. Clinical electrophysiology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Canadian Institutes of Health Research
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Syncope and Autonomic Disorders
- Physical Sciences › Engineering › Safety, Risk, Reliability and Quality › Traffic and Road Safety
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
- Keywords
- vasovagal syncope, driving, motor vehicle accidents, metoprolol, fludrocortisone, road safety
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