What is the minimum left ventricular ejection fraction (LVEF) required for certifying a driver with congestive heart failure?

The minimum left ventricular ejection fraction (LVEF) required for certifying a driver with congestive heart failure is 40%. This threshold is based on the relationship between the LVEF and the ability to perform the demands of driving safely, especially in the commercial vehicle context. A LVEF of 40% is deemed the minimum acceptable because it indicates that the heart is functioning adequately enough to support physical activities, including driving.

If the LVEF falls below this level, the risks associated with reduced cardiac output and potential decompensation may pose significant safety concerns—not just for the driver, but for other road users as well. Maintaining an LVEF of 40% or above helps ensure the individual has sufficient cardiac reserve to manage unexpected stressors, such as abrupt movements or high levels of physical exertion involved in certain driving situations.