[Legal aspects of driving and cardiovascular diseases : Guidelines of German Cardiac Society and the German government in comparison]

BACKGROUND

The general regulations for an active participation in the road traffic in the Federal Republic of Germany are laid down in the Driving License Ordinance ("Fahrerlaubnisverordnung" ) (including appendices). Cardiovascular diseases with a need for precautionary measures and the circumstances according to which the driving fitness is to be determined are reviewed in appendix 4 of the ordinance. The guidelines of the Federal Highway Research Institute ("Bundesanstalt für Straßenwesen") must also be considered when assessing the fitness to drive.

OBJECTIVES

Presentation of the current legal recommendations in the assessment of the driving fitness in the respect to cardiovascular diseases.

MATERIALS AND METHODS

The current official regulations and the recommendations on the fitness to drive in the case of cardiovascular diseases were assessed. In addition, the pocket guidelines of the German Society for Cardiology (DGK) on the subject were reviewed.

RESULTS

As the type of vehicle and time at the wheel influence the probability and the extent of damage in the case of a traffic accident, the official requirements for driving aptitude distinguish between private (group 1) and professional drivers (group 2). The official recommendations for assessing fitness to drive in the case of cardiac arrhythmias, device therapy, coronary heart disease, cardiac insufficiency, valve diseases and syncope are presented.

CONCLUSION

Driving fitness plays an important role in the cardiological patient collective and should be determined in accordance with the official recommendations. For everyday clinical practice, the DGK recommendations for fitness to drive are presented in a clearer and more practice-relevant manner.

Acute kidney injury after in-hospital cardiac arrest in a predominant internal medicine and cardiology patient population: incidence, risk factors, and impact on survival

Introduction

Prognosis of survivors from cardiac arrest is generally poor. Acute kidney injury (AKI) is a common finding in these patients. In general, AKI is well characterized as a marker of adverse outcome. In-hospital cardiac arrest (IHCA) represents a special subset of cardiac arrest scenarios with differential predisposing factors and courses after the event, compared to out-of-hospital resuscitations. Data about AKI in survivors after in-hospital cardiac arrest are scarce.

Methods

In this study, we retrospectively analyzed patients after IHCA for incidence and risk factors of AKI and its prognostic impact on mortality. For inclusion in the analysis, patients had to survive at least 48 h after IHCA.

Results

A total of 238 IHCA events with successful resuscitation and survival beyond 48 h after the initial event were recorded. Of those, 89.9% were patients of internal medicine, and 10.1% of patients from surgery, neurology or other departments. In 120/238 patients (50.4%), AKI was diagnosed. In 28 patients (23.3%), transient or permanent renal replacement therapy had to be initiated. Male gender, preexisting chronic kidney disease and a non-shockable first ECG rhythm during resuscitation were significantly associated with a higher incidence of AKI in IHCA-survivors. In-hospital mortality in survivors from IHCA without AKI was 29.7%, and 60.8% in patients after IHCA who developed AKI (p < 0.01 between groups).

By multivariate analysis, AKI after IHCA persisted as an independent predictor of in-hospital mortality (HR 3.7 (95% CI 2.14–6.33, p ≤ 0.01)).

Conclusion

In this cohort of survivors from IHCA, AKI is a frequent finding, with adverse impact on outcome. Therefore, therapeutic strategies to prevent AKI in post-IHCA patients are warranted.