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Green-light for some athletes with CVD to compete

For the first time, joint recommendations may permit participation in competitive sports for some athletes diagnosed with a specific type of arrhythmia, and for others with implanted rhythm devices according to a joint statement from the American Heart Association and American College of Cardiology.1

To calculate the risk of sudden cardiac arrest, a panel analysed detailed medical reports on competitive athletes with different types of cardiovascular disease (CVD). In addition to arrhythmia, these diseases include heart valve damage, hypertension, and arteriosclerosis, amongst others.

The new recommendations apply only to athletes with diagnosed CVD who participate in competitive level sports directed by a coach (i.e. football, basketball, baseball and others). They do not apply to those who occasionally participate in sports for fun or exercise.

Previous recommendations noted that the risk of sudden cardiac arrest during competitive sports was too high for many athletes with long QT syndrome. New research indicates, however, that the risk of sudden cardiac arrest is lower than previously thought for these patients.

7 - New recommendations green-light some athletes with heart disease to compete HPSimilarly, the new research shows a lower risk of sudden cardiac arrest among some competitive athletes with some disorders treated by an implanted medical device such as pacemakers, and implantable cardioverter defibrillators (ICDs). Under the new recommendations, some of these athletes now may be able to compete – with their healthcare provider’s approval, since every patient is different.

“These recommendations are intended to help healthcare providers and competitive athletes make individualised decisions based on the most current scientific research, the patient’s understanding of their risk and the healthcare provider’s clinical judgment, but are not intended to establish absolute mandates or to make the general medical (and legal) standard of care applicable to all competitive athletes,” said Dr Barry Maron, co-chair of the writing committee and director of the Hypertrophic Cardiomyopathy Center at the Minneapolis Heart Institute Foundation.

“It should be noted that the guidance for patients with hypertrophic cardiomyopathy has not changed – we still recommend avoiding intense competitive sports for people who have this condition,” Dr Maron said.

Professor Douglas P Zipes (Indiana University School of Medicine, Indiana, USA), co-chair of the statement writing group, said: “The ultimate incentive is to prevent sudden cardiac death in the young, although it is also important not to unfairly or unnecessarily remove individuals from a healthy athletic lifestyle”.

The scientific statement also provides recommendations for evaluating other congenital, genetic and acquired cardiac conditions that could increase the risk of sudden cardiac arrest among competitive athletes, as well as emphasising the importance of avoiding performance-enhancing drugs which also increase risk. The statement notes it is also critical for competitive athletes and their coaches to learn how to use an automated external defibrillator (AED), in a person who has experienced a cardiac arrest.

“The panel recognises and strongly supports the well-documented health benefits of exercise, with regular physical activities encouraged for those individuals who have been removed from organized competitive athletics,” Professor Zipes said.

The organisations have not changed their screening recommendations, and continue to recommend that healthcare professionals use a checklist of 14 key elements for screening young people, including athletes, age 12–25, for congenital and genetic heart disease.

If any of the elements are positive, further testing may be needed, but initial screening using electrocardiograms (ECGs) to detect underlying genetic and congenital heart disease in this age group prior to the checklist has not been shown to save lives and is not recommended by either the American Heart Association or the American College of Cardiology.

References

1. Maron BJ, Zipes DP, Kovacs RJ. Eligibility and disqualification recommendations for competitive athletes with cardiovascular abnormalities: preamble, principles, and general considerations: a scientific statement from the American Heart Association and American College of Cardiology. Circulation 2015;132. http://dx.doi.org/10.1161/CIR.0000000000000236

Published on: November 24, 2015

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ENDORSED BY

  • ArrhythmiaAlliance
  • Stars
  • Anticoagulation Europe
  • Atrial Fibrillation Association
 

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