ACC and AHA release recommendations for athletes with heart disease

Competitive athletes who participate in team sports such as football, basketball and baseball may be able to continue to play after being diagnosed with long QT syndrome or certain heartbeat disorders, according to an expert consensus recommendation from the American College of Cardiology (ACC) and American Heart Association (AHA).

Previously, the ACC and AHA said the risk of sudden cardiac arrest in competitive sports was too high for patients with long QT syndrome or heartbeat disorders that are treated with pacemakers and implantable cardioverter defibrillators.

However, Barry Maron, MD, co-chair of the writing committee and director of the Hypertrophic Cardiomyopathy Center at the Minneapolis Heart Institute Foundation, said in a news release that patients with hypertrophic cardiomyopathy should continue avoid competitive sports.

The recommendations were simultaneously published online in Circulation and the Journal of the American College of Cardiology on Nov. 2.

The panel members assessed competitive athletes with irregular heartbeat, heart valve damage, high blood pressure, narrowing of the blood vessels and other types of heart disease.

“This document is concerned only with organized and sanctioned competitive sports participation, such as most commonly found in middle school, high school, and college, and not with purely recreational physical activities,” the panel members wrote. “The panel recognizes and strongly supports the well-documented health benefits of exercise, with regular physical activities encouraged for those people who have been removed from organized competitive athletics, or who elect to participate in a wide range of recreational sporting activities.”

The ACC had previously published three documents addressing the eligibility and disqualification criteria for athletes with cardiovascular diseases. Before this update, the latest recommendation was released in 2005.

The researchers defined a competitive athlete as “one who participates in an organized team or individual sport that requires regular competition against others as a central component, places a high premium on excellence and achievement, and requires some form of systematic (and usually intense) training.”

They noted that sudden cardiac deaths in competitive athletes occur more often in males than females by a 9 to 1 margin. Among athletes who are younger than 35, the most common causes of sudden cardiac deaths are genetic heart diseases and congenital coronary anomalies.

The ACC and AHA recommend that healthcare professionals use a 14-point checklist to screen young people and athletes between 12 and 25 years old for congenital and genetic heart disease. They do not recommend using ECGs to initially screen for underlying genetic and congenital heart disease in this age group.

“These recommendations are intended to help healthcare providers and competitive athletes make individualized 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,” Maron said.