Regulatory and occupational affairs of the heart

Regulatory authorities may prevent selected patients with heart disease from pursuing specific occupations and leisure activities in order to protect the individual, those around them, or the interests of the institution in question. Clinicians are often challenged as to the rationale for these restrictions, and may be asked to provide advice on the safety of a diverse range of recreational activities. They should be aware that guidance is frequently updated and may vary between countries and jurisdictions. This article will discuss the concept of acceptable risk and outline the scientific basis for restricting activities in patients with cardiovascular disease. It includes a summary of the regulations used to determine fitness to drive in the United Kingdom, an account of new British recommendations for passenger fitness to fly, and a discussion of the factors that may influence advice to divers, mountaineers and professional athletes.