Experts in cardiology are offering updated recommendations for athletes with heart conditions, aimed at enhancing collaboration between medical professionals and patients to better assess the risks associated with competitive sports. Traditionally, individuals with cardiovascular irregularities have been discouraged from engaging in competitive athletic activities. However, a recent report issued by the American Heart Association and the American College of Cardiology indicates there is evidence that many athletes, regardless of age, can safely participate in sports even when facing certain heart conditions.
Published as a scientific statement in the journal Circulation as well as the Journal of the American College of Cardiology, the report outlines essential clinical practices for athletes ranging from children to adults. Dr. Jonathan H. Kim, an associate professor and director of sports cardiology at Emory University School of Medicine, led the panel that authored this statement. The document classifies competitive athletes as both professional and amateur individuals who strive for achievement, engaging in activities like marathons, triathlons, and team sports.
The previous report on “athlete’s heart” was released in 2015. Over the last decade, new studies examining congenital heart defects, arrhythmias, and other cardiovascular conditions have suggested that while risks do exist, they may not be as severe as once believed. “We recognize situations where an athlete’s risks outweigh the benefits of competition due to cardiovascular issues,” stated Kim, noting that the statement serves as a tool for open discussions about risks and advantages.
Central to the report is the concept of shared decision-making, wherein healthcare professionals engage patients as informed partners in discussions that consider their personal aspirations instead of merely imposing treatment plans. This modern approach aims to reconsider the automatic disqualification of athletes with heart conditions, which was a common practice in the past.
The statement encompasses a wider range of athletes than previous iterations. It contains evaluations particularly targeting “masters athletes,” defined as those aged 35 and up who may face conditions such as coronary disease, atrial fibrillation, or valve issues. It also provides insights for those participating in extreme sports, those exercising at high altitudes, and even those wishing to compete while pregnant.
Among other key points, the report stresses the significance of comprehensive cardiac screening for student athletes, recommending a 14-point evaluation that includes physical examinations and health history queries. The document indicates that conducting electrocardiograms (EKGs) is a “reasonable” preventive measure for asymptomatic athletes, provided those interpreting the results are experts in athletic assessments. Ensuring equitable access to follow-up resources for all athletes undergoing screenings is also highlighted.
Furthermore, the report outlines guidance for athletes on blood-thinning medications, suggesting that potential trauma risks from certain sports like baseball or competitive cycling must be taken into account. Additionally, it revises prior recommendations regarding athletes who have cardiomyopathies—previously, individuals with this condition were advised against competing. The new statement allows room for some genetically-influenced cardiomyopathies under medical supervision.
Guidance is also updated for young athletes with myocarditis, recommending that they may return to play sooner than the previously suggested three to six months based on current studies indicating quicker recovery times. The report further addresses young athletes with aortopathy and specific heart rhythm disorders without strictly categorizing sports but instead viewing them on a spectrum of strength and endurance tailored to the individual.
Finally, the report expresses a need for more research to delve into lingering questions regarding athletes and cardiovascular risks. Notably, it raises concerns over the increased risk of sudden cardiac death in young Black athletes, calling for further investigation into social disparities that may affect health outcomes for this demographic—acknowledging the complexities surrounding health in sports as indicative of broader societal issues.
