COMMERCIAL DRIVERS WITHOUT KNOWN CORONARY HEART DISEASE (CHD) 2002 Cardiovascular Conference Report Recommendation Tables, Page 35 PHYSIOLOGY/ DIAGNOSIS CERTIFICATION RE-CERTIFICATION FUNCTIONAL Asymptomatic, healthy Low CHD event risk. Yes, if asymptomatic. Biennial Assess for clinically Rarely disqualifying apparent risk factors. Use, alone. when possible, Framingham risk score model to predict 10-year CHD event risk; Increasing age is a surrogate marker for increasing atherosclerotic plaque burden. Asymptomatic, high risk Sub-clinical coronary Yes, if asymptomatic. Annual person (as designated by atherosclerosis is a No if: CHD risk-equivalent concern. Abnormal ETT;** condition)* Ischemic changes on High-risk status requires Asymptomatic, high risk close physician follow-up ECG; † person > 45 years with and aggressive Functional incapacitation multiple risk factors for comprehensive risk factor by one of conditions. management. CHD *CHD risk equivalent is defined as presence of diabetes mellitus, peripheral vascular disease, or Framingham risk score predicting a 20% CHD event risk over the next 10 years. ** Abnormal Exercise Tolerance Test (ETT) is defined by an inability to exceed 6 METS (beyond completion of Stage II, or 6 minutes) on a standard Bruce protocol or the presence of ischemic symptoms and/or signs (e.g., characteristic angina pain or 1 mm ST depression or elevation in 2 or more leads), inappropriate SBP and/or heart rate responses (e.g., inability in the maximal heart rate to meet or exceed 85% of age-predicted maximal heart rate), or ventricular dysrhythmia. Ischemic ECG changes are defined by the presence of new 1 mm ST-segment elevation or depression † and/or marked T wave abnormality.
COMMERCIAL DRIVERS WITHOUT KNOWN CORONARY HEART DISEASE (CHD) 2002 Cardiovascular Conference Report Recommendation Tables, Page 35 DIAGNOSIS PHYSIOLOGY/ FUNCTIONAL CERTIFICATION RE-CERTIFICATION Asymptomatic, healthy Low CHD event risk. Assess for clinically apparent risk factors. Use, when possible, Framingham risk score model to predict 10-year CHD event risk; Increasing age is a surrogate marker for increasing atherosclerotic plaque burden. Yes, if asymptomatic. Rarely disqualifying alone. Biennial Asymptomatic, high risk person (as designated by CHD risk-equivalent condition)* Asymptomatic, high risk person > 45 years with multiple risk factors for CHD Sub-clinical coronary atherosclerosis is a concern. High-risk status requires close physician follow-up and aggressive comprehensive risk factor management. Yes, if asymptomatic. No if: Abnormal ETT;** Ischemic changes on ECG; † Functional incapacitation by one of conditions. Annual *CHD risk equivalent is defined as presence of diabetes mellitus, peripheral vascular disease, or Framingham risk score predicting a 20% CHD event risk over the next 10 years. ** Abnormal Exercise Tolerance Test (ETT) is defined by an inability to exceed 6 METS (beyond completion of Stage II, or 6 minutes) on a standard Bruce protocol or the presence of ischemic symptoms and/or signs (e.g., characteristic angina pain or 1 mm ST depression or elevation in 2 or more leads), inappropriate SBP and/or heart rate responses (e.g., inability in the maximal heart rate to meet or exceed 85% of age-predicted maximal heart rate), or ventricular dysrhythmia. † Ischemic ECG changes are defined by the presence of new 1 mm ST-segment elevation or depression and/or marked T wave abnormality.