Cardiovascular Care of College Student-Athletes

Authors:
Hainline B, Drezner JA, Baggish A, et al.
Citation:
Interassociation Consensus Statement on Cardiovascular Care of College Student-Athletes. J Am Coll Cardiol 2016;67:2981-2995.

The National Collegiate Athletic Association (NCAA) convened a multidisciplinary task force in 2014 to discuss and evaluate cardiovascular concerns in collegiate student athletes, and to develop an interassociation consensus statement and recommendations. The primary focus was on sudden cardiac death (SCD) and the utility of screening with or without an electrocardiogram (ECG). The following are 10 points to remember:

  1. Although there is a general health benefit associated with regular exercise, sports participation presents additional risks for injury. In addition, sports activities (during training and during competition) have been associated with an increased risk for SCD.
  2. Research based on NCAA athletes from 2003-2013 suggests that the overall risk of SCD in an NCAA student athlete during or soon after exertion is approximately 1 in 54,000 athletes per year (0.0019%); with a higher risk in men (1:38,000 [0.0026%]) than women (1:122,000 [0.00082%]), and in African-American (1:22,000 [0.0045%]) than in Caucasian athletes (1:68,000 [0.0015%]). The student group at highest risk was male basketball players (1:9,000 [0.011%]), and the risk of SCD among Division I African-American male basketball players was (1:52,000 [0.019%]).
  3. The primary purpose of pre-participation evaluation is to identify conditions that might put the student-athlete at unreasonable risk of death or catastrophic injury, with the potential to modify and reduce the risk through individualized management.
  4. The NCAA supports pre-participation cardiovascular screening using a comprehensive personal and family history and physical examination, such as the American Heart Association (AHA) 14-point recommendations and/or the Pre-Participation Physical Evaluation Monograph, Fourth Edition (PPE-4). The pre-participation evaluation process should be formalized and in writing.
  5. The consensus statement recognizes that many member institutions use an electrocardiogram (ECG) as part of pre-participation. The following guidance is offered:
    • A cardiovascular specialist with the requisite expertise should be identified to read athlete ECGs and to coordinate any subsequent testing.
    • The use of ECG screening among all student athletes versus targeted high-risk groups should be discussed and agreed upon.
    • ECG screening should be implemented as part of an integrated cardiovascular screening using AHA 14-point recommendations or the PPE-4.
    • ECGs should be interpreted using modern standards that distinguish normal findings related to physiological cardiac remodeling in trained athletes from abnormalities suggestive of underlying cardiac pathology.
  6. A written emergency action plan for the treatment of cardiac arrest is strongly recommended.
  7. Anticipated responders should be trained in cardiopulmonary resuscitation (CPR) and the use of automated external defibrillator (AED) use. In addition to athletic trainers and team physicians, training should include strength and conditioning coaches, sport coaches, and potentially administrative personnel.
  8. There should be easy access (within a 3-minute walk) to early defibrillation for all high-risk locations; including weight rooms, strength and conditioning rooms, basketball courts, football/soccer/lacrosse/softball fields, track and field locations, and other indoor training facilities.
  9. AEDs should be functioning and properly charged.
  10. On-site responder and AED programs should be integrated with local emergency medical services. Emergency response plans should be reviewed and practiced at least annually.

Clinical Topics: Arrhythmias and Clinical EP, Diabetes and Cardiometabolic Disease, Prevention, Sports and Exercise Cardiology, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Exercise

Keywords: Arrhythmias, Cardiac, Athletes, Basketball, Cardiopulmonary Resuscitation, Death, Sudden, Cardiac, Defibrillators, Electrocardiography, Emergency Medical Services, Exercise, Heart Arrest, Physical Examination, Physical Exertion, Risk, Secondary Prevention, Students


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