Journal Watch, April 15, 2025Revised Guidance for Athletes with Cardiovascular Disease: A Shift Toward Shared Decision MakingMark S. Link, MD, reviewing Kim JH et al. J Am Coll Cardiol 2025 Mar 18Updated recommendations move away from universal disqualification, emphasizing individualized risk assessment and shared decision making for athletes with heart conditions.
Sponsoring Organizations: American Heart Association (AHA) and American College of Cardiology (ACC)
Background
The Bethesda conference proceedings on athletes and cardiovascular conditions were published in 1985, 1994, and 2005, and changed to a scientific statement that was published in 2015. Traditionally, guidance often restricted athletes with cardiovascular disease from competitive sports due to concerns about sudden cardiac death. However, evolving evidence challenges these blanket restrictions.
Objective
The AHA and ACC convened an expert panel to review emerging data and update recommendations. This statement, in its fifth iteration, integrates 40 years of research, emphasizing individualized risk assessment, disease-specific considerations, and the role of shared decision making in determining sports eligibility.
Key Points
Shift from paternalism to shared decision making: Eligibility decisions should prioritize athlete autonomy while carefully assessing risk.Hypertrophic cardiomyopathy: Athletes with hypertrophic cardiomyopathy may continue competing after comprehensive evaluation, challenging prior assumptions that all cases require disqualification.
Myocarditis recovery: Athletes with preserved left ventricular function may return to sports within 4–6 weeks, instead of the previously recommended 3–6 months, if inflammation has resolved.
Implantable cardioverter defibrillators (ICDs): Athletes with ICDs can safely return to competitive sports in many cases, contrary to prior restrictions.
Arrhythmias and channelopathies: Some athletes with long QT syndrome and catecholaminergic polymorphic ventricular tachycardia may compete under expert supervision.
Sports classification update: Instead of rigid categories, sports are now evaluated on a continuum of endurance, strength, and collision risk.
Anticoagulation and contact sports: New risk-stratified recommendations outline when athletes on blood thinners can safely participate in sports with varying levels of impact.
Comment
This extensive document reflects a significant shift in sports cardiology, emphasizing patient-centered care over rigid exclusion and will be a useful resource for clinicians when they see athletes and even nonathletes with cardiac conditions who want to exercise or compete in sports. I encourage providers who see these patients to download this encyclopedia and keep it readily available.Note: Dr. Link was a member of the guideline writing committee.
Citations
Kim JH et al. Clinical considerations for competitive sports participation for athletes with cardiovascular abnormalities: A scientific statement from the American Heart Association and American College of Cardiology. J Am Coll Cardiol 2025 Mar 18; 85:1059. (Δεν είναι ορατοί οι σύνδεσμοι (links).
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