Consensus Statement Offers Guidance on Preventing Sudden Cardiac Death in Athletes

A new consensus statement, published April 15 in the Journal of the American College of Cardiology, establishes guidance for conducting pre-participation screenings of college athletes and encourages emergency action plans for quickly responding to sudden cardiac arrest. The statement was developed by a 29-person task force convened by the National Collegiate Athletic Association (NCAA) in September 2014 that included multidisciplinary physician specialists and athletic trainers representing national sports and medical associations, including the ACC.

The NCAA currently requires every student-athlete to undergo a pre-participation evaluation conducted by a licensed medical doctor or doctor of osteopathic medicine prior to participation in any NCAA sport. However, the purpose of that evaluation is not defined, nor is it required to be conducted or reviewed by a team physician.

The task force addressed concerns over cardiovascular care for student-athletes – including how to conduct screenings – and came to a consensus on recommendations for identifying cardiovascular conditions and responding to unanticipated cardiac events in athletic venues. The common element of screening objectives is to identify potentially life-threatening conditions for which participation in competitive sports would place an athlete at an elevated level of risk.

The ACC and the American Heart Association (AHA) both recommend taking an athlete’s family history using the AHA’s 14-point questionnaire and conducting a physical examination to determine the athlete’s risk of cardiovascular disease before the athlete participates in sports. Routine, large-scale use of electrocardiograms is not recommended by either the ACC or the AHA. However, the consensus statement acknowledges that NCAA-member institutions that have the ability to conduct ECGs on all athletes are already doing so. It outlines specific guidance for conducting ECGs in an entire student-athlete population, including the guidance that only physicians trained according to ACC/AHA/Heart Rhythm Society recommendations should be conducting the ECGs.

The field of sports cardiology is a highly specialized segment of cardiology and very few physicians and institutions across the country have the knowledge base, skill and experience in this discipline to accurately interpret an athlete’s ECG. This could put smaller colleges and universities located in low-density population areas at a disadvantage when it comes to accessing expertise in sports cardiology. The task force recommended establishing regional referral centers that can provide pre-participation ECG interpretation, clarity on the cardiovascular status of athletes with irregular findings during their pre-participation screening, evaluations of new cardiovascular symptoms that develop during training or competition, and consultations on when a player with a cardiac issue is cleared to play.

A major finding of the task force was the need to streamline how cardiac arrest in student-athletes is recognized and responded to. It was recommended that all universities have a written emergency action plan for treatment of cardiac arrest that is well-rehearsed, with different protocol for treatment during a practice versus during a game/championship event since treatment during a game can be vastly different due to traffic delays and access problems for emergency medical services.

The task force recommended that the emergency action plan include training anticipated responders, establishing an emergency communications system, ensuring automated external defibrillators are easily accessible and properly charged, integrating on-site response protocols with the local emergency management system, and practicing and reviewing the plan at least annually.

“This document is the result of multiple medical organizations and stakeholders, including athletic trainers, sports medicine physicians, cardiologists, collegiate athletes and administrators,” said Michael Scott Emery, MD, FACC, co-chair of the ACC Sports and Exercise Cardiology Council and a co-author of the paper. “This strategy is aimed to shift public health and cultures, not legislation. It is a broad piece that emphasizes not only pre-participation screening but also emergency actions plans, AED/CPR, future research initiatives and the development of referral centers for specialized assessment and management of potential cardiovascular related issues specific to the athlete. It is supportive of current ACC/AHA guidelines but also acknowledges that many universities are doing advanced cardiac screening (ECGs), and then provides a set of standards to have in place for those that do elect to provide ECGs as part of their standard pre-participation evaluation.”

The consensus statement is being co-published in the British Journal of Sports Medicine and the April issue of the Journal of Athletic Training. In addition to the ACC, the task force included representation from the American Academy of Pediatrics’ Council on Sports Medicine and Physical Fitness, the American College of Sports Medicine, AHA, the American Medical Society for Sports Medicine, the American Orthopedic Society for Sports Medicine, the American Osteopathic Academy of Sports Medicine, the National Athletic Trainers’ Association, the NCAA Committee on Competitive Safeguards and Medical Aspects of Sports, the NCAA Student Athlete Advisory Council, the National Federation of State High School Associations, and the National Strength and Conditioning Association.

Clinical Topics: Arrhythmias and Clinical EP, Congenital Heart Disease and Pediatric Cardiology, Sports and Exercise Cardiology, Implantable Devices, SCD/Ventricular Arrhythmias, CHD and Pediatrics and Arrhythmias, CHD and Pediatrics and Prevention, Sports and Exercise and Congenital Heart Disease and Pediatric Cardiology

Keywords: American Heart Association, Athletes, Cardiopulmonary Resuscitation, Child, Consensus, Death, Sudden, Cardiac, Defibrillators, Electrocardiography, Emergency Medical Services, Orthopedics, Osteopathic Medicine, Pediatrics, Physical Examination, Physical Fitness, Public Health, Referral and Consultation, Societies, Medical, Sports, Sports Medicine, Universities

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