Heart Failure Is a Risk Factor for Incident Driving Cessation Among Community-Dwelling Older Adults: Findings From a Prospective Population Study

• Published in: Journal of cardiac failure 2011-12, Vol.17 (12), p.1035-1040
• Main Authors: Sims, Richard V., MD, Mujib, Marjan, MD, MPH, McGwin, Gerald, MS, PhD, Zhang, Yan, MS, MSPH, Ahmed, Mustafa I., MD, Desai, Ravi V., MD, Aban, Inmaculada B., PhD, Sawyer, Patricia, PhD, Anker, Stefan D., MD, PhD, Ahmed, Ali, MD, MPH
• Format: Article
• Language: English
• Subjects: Age Factors; Aged; Aging - physiology; Aging - psychology; Automobile Driving - psychology; Cardiovascular; Confidence Intervals; Female; Health Status; Heart Failure; Humans; incident driving cessation; Male; older adults; population study; Prevalence; Prospective Studies; Psychometrics; Residence Characteristics; Risk Factors; Self Report; Vision Disorders
• ISSN: 1071-9164; 1532-8414
• DOI: 10.1016/j.cardfail.2011.08.014

Background Heart failure (HF) patients often depend on driving for access to specialty care. We analyzed a public-use copy of the Cardiovascular Health Study (CHS) data to determine if HF is a risk factor for driving cessation and to identify other risk factors for driving cessation among those with HF. Methods and Results Of the 5,383 community-dwelling drivers aged ≥65 years (mean age 73 years, 55% women, 13% African American), 839 had HF: 246 had baseline prevalent HF and 593 developed incident HF before driving cessation during 9 years of follow-up. Incident driving cessation occurred at rates of 3,980 and 3,709 per 10,000 person-years of follow-up for those with and without HF, respectively (unadjusted hazard ratio [HR] associated with HF as a time-varying variable: 2.13, 95% confidence interval [CI] 1.83–2.47; P < .001). This association remained unchanged after multivariable risk adjustment (HR 1.43, 95% CI 1.21–1.68; P < .001). Among the 839 older drivers with HF, independent predictors for incident driving cessation were age ≥75 years (HR 1.99, 95% CI 1.44–2.73; P < .001), female gender (HR 1.93, 95% CI 1.37–2.74; P < .001), difficulty walking half a mile (HR 1.47 (1.04–2.08); P  = .028), vision problems (HR 1.47, 95% CI 1.07–2.02; P  = .018), and stroke as a time-varying covariate (HR 1.96, 95% CI 1.38–2.79; P < .001). Conclusions HF is an independent risk factor for incident driving cessation among community-dwelling older drivers. Several patient characteristics predicted driving cessation in older HF patients, which may be targets for interventions to prevent driving cessation among these patients.