Editor's Note:

Dear Sports and Exercise Cardiology Enthusiasts:

Care of the Athletic Heart 2019 (CAH), directed by Matthew Martinez MD, and Jonathan Kim, MD, convened June 20-22 at the American College of Cardiology's Heart House in Washington, DC. The overflow capacity of attendees and number of live streaming participants exceeded 220 in total. In the next few weeks, we will post summaries of key sessions written by cardiology Fellows-in-Training (FIT). Most of them were presenters at CAH, and all are active in the Sports and Exercise Cardiology Section FIT Interest Group.

The full CAH agenda can be accessed here. Please feel free to contact Chris Driver (cdriver@acc.org) or me (chungeug@umich.edu) with any questions.

Thank you to the FITs for all their hard work. We hope you enjoy the summaries.

Eugene H Chung, MD, FACC
Editorial Team Lead, Sports & Exercise Cardiology Clinical Topic Collection

Background
Dr. Tess Saarel started off this session by defining and highlighting the salient features of shared decision making (SDM). Unique challenges in caring for athletes include appreciation of the nuances of disease pathophysiology and incorporation of exercise goals with the athlete. The following are eight essential steps for implementing SDM when caring for athletes.

1. Develop a thorough understanding of the risks of sports participation for the athlete, including but not limited to arrhythmias and heart failure. For example, in patients with an implantable cardioverter defibrillator, retrospective and prospective registries over the last 15 years support a SDM approach to permitting sports participation.^1-3
2. Recognize the pivotal benefits of sports participation for the athlete. These include the health, physical and social benefits along with less publicized perks such as admissions, scholarships and fringe benefits.
3. Provide education about the athlete's condition to all the stakeholders: families, coaches, schools and the workplace. Visual flowcharts, formal decision aids and/or a list of frequently asked questions (FAQs) can be helpful.
4. Assess family values. For some families, participation in sports has been the way of life, and they will be willing to accept some health risks along the way. For many others, sports does not take priority over healthy living.
5. Perform SDM. The sports cardiologist must have a detailed discussion with the patient about his or her goals. It is paramount that the physician presents the most relevant and recent literature in the field to aid the decision making process.
6. Document the discussion in its entirety. One of the challenges of sports medicine is the legal ramifications that surround the decision of allowing an athlete with heart disease to participate in competitive sports. We must understand that these processes exist for a reason, and attention to detail while documenting can be an essential tool for the treating physician.
7. If SDM leads to sports participation, then a mandatory next step is to ensure an emergency action plan is in place. For example, an automatic external defibrillator should be on site and easily reachable; team members and staff need to be trained in basic life support, and a means for contacting first responders must be in place.
8. Reassess the athlete's physical and mental conditioning every six to twelve months. SDM is a dynamic process and should be revisited at every opportunity.

References

1. Lampert R, Cannom D, Olshansky B. Safety of sports participation in patients with implantable cardioverter defibrillators: a survey of heart rhythm society members. J Cardiovasc Electrophysiol 2006;17:11-5.
2. Lampert R, Cannom D. Sports participation for athletes with implantable cardioverter-defibrillators should be an individualized risk-benefit decision. Heart Rhythm 2008;5:861-3.
3. Lampert R, Olshansky B, Heidbuchel H, et al. Safety of sports for athletes with implantable cardioverter-defibrillators: results of a prospective, multinational registry. Circulation 2013;127:2021-30.

Clinical Topics: Arrhythmias and Clinical EP, Heart Failure and Cardiomyopathies, Sports and Exercise Cardiology, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Acute Heart Failure

Keywords: Athletes, Sports, Sports Medicine, Defibrillators, Implantable, Fellowships and Scholarships, Prospective Studies, Retrospective Studies, Decision Making, Arrhythmias, Cardiac, Decision Support Techniques, Heart Failure, Registries

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