Competitive Sport Participation Among Athletes With Heart Disease
A Call for a Paradigm Shift in Decision Making
This article requires a subscription to view the full text. If you have a subscription you may use the login form below to view the article. Access to this article can also be purchased.
More than 8 million young men and women participate in competitive high school or collegiate sports in the United States annually. For the vast majority of these young men and women, sport participation plays an invaluable role in promoting healthy physical, emotional, and cognitive development. In rare cases, however, seemingly healthy athletes with occult cardiovascular disease (CVD) die suddenly during sport participation. Strategies to reduce these highly visible tragedies, including preparticipation screening and medical oversight of training and competition, are well established and can lead to the identification of athletes with undiagnosed CVD. For the competitive athlete diagnosed with CVD, determination of future athletic eligibility is a critical step in a care continuum that begins with diagnosis and continues through long-term treatment. Fundamentally, eligibility determination is a quest to reduce the risk of future sudden death while simultaneously avoiding unnecessary sport restriction. This process may be challenging for the patient and family, clinicians, and schools or sporting organizations. Accordingly, the American College of Cardiology (ACC), the American Heart Association (AHA), and the Heart Rhythm Society (HRS) provide eligibility recommendations for competitive athletes with established CVD.
Until recently, the 2005 update of the 36th Bethesda Conference statement, an encyclopedic compendium of CVD diagnoses with binary yes-or-no eligibility recommendations for each diagnosis, served as the standard of care.1 This binary approach to eligibility inherently facilitated paternalistic decision making, in which doctors, schools, and athletic organizations were encouraged/expected to permit or restrict sport participation with little or no input …