This post was authored by Michael S. Emery, MD, FACC, co-chair of the ACC’s Sports and Exercise Cardiology Section Leadership Council.

With the publication of the white paper: Sports and Exercise Cardiology in the United States: Cardiovascular Specialists as Members of the Athlete Healthcare Team in the Journal of the American College of Cardiology, the emerging field of sports cardiology begins laying the foundation as an autonomous subspecialty in the U.S. As we continue to recognize the unique physiology and needs of athletes and exercising individuals of all ages, it is important to continue to define the role we as cardiologists play in the integrated health care charged with caring for these individuals. The field of sports cardiology is then a natural evolution not only within cardiology but also from the continued growth of sports medicine subspecialties (e.g. sports podiatry, sports neurology, diving medicine, etc.) John DiFiori, MD, the immediate past president of the American Medical Society of Sports Medicine (AMSSM) and chief of the Division of Sports Medicine and Non-operative Orthopedics at UCLA commented, “The AMSSM is excited to learn about the development of a distinct Sports and Exercise Cardiology discipline within the ACC. We look forward to continuing to collaborate with the ACC in the clinical care of athletes and active individuals, as well as in educational and research efforts.”

With the increasing population of athletes and exercising individuals and the continued recognition of these persons as unique cardiac patients, there has developed a need to understand the epidemiology of disease and risks beyond the traditional cardiac patient. It behooves the sports cardiology specialist to grasp the specific athletic adaptations that occur, the unique and specialized cardiac testing, and the multidimensional management of these rather unique patients.

What is currently a rather small community compared to other subspecialties, the white paper illustrates the broad range of cardiovascular issues within the field of sports cardiology including the need to involve experts across multiple specialties (i.e. electrophysiology, imaging, genetics, etc.) We are at the beginning of a dramatic increase in the knowledge base of athletes, which will allow for a more comprehensive ability to care for them and provide standardized advice backed by the best evidence.

The limitations in standard medical and cardiovascular training for practitioners to be able to adequately care for athletes are spelled out in the paper. John Vyselaar, MD, FRCPC, a community-based cardiologist in Vancouver, BC, Canada who provides consultative services to the Vancouver Whitecaps of Major League Soccer (MLS) and the BC Lions of the Canadian Football League, notes, “I received no training during residency and fellowship in athlete care. Recommendations from other practitioners are always well-intentioned and carefully considered; however, they suffer because of a lack of experience with athletes, awareness of cardiovascular adaptations to exercise, and understanding of how to approach common athletic issues such as return to play decisions.”

Gaps in research, science and quality are another issue to address with the advancement of sports cardiology. The white paper also “highlights the lack of data in the field that is crucially necessary for accurate decision-making and management of athletes,” stated Todd Miller, MD, FACC, professor of medicine for the Mayo Clinic, medical director of the Sports Cardiology Clinic and co-director of the Nuclear Cardiology Laboratory. “For people who practice sports cardiology in an academic setting, it should serve as a stimulus for the importance of standardizing training in the field and initiating research projects to address the highest priority issues where data is lacking to inform management decisions.”

With the development of the ACC Sports and Exercise Cardiology Section, the successful integration of sports-specific content within the ACC Annual Scientific Session and the launch of the Annual Sports Cardiology Summit, the field of sports cardiology has arrived. The overarching theme of improving cardiovascular care of athletes and exercising individuals from an athlete-centered approach via education, publications, research, advocacy and an integrated team approach is the future. This white paper is the first major step in organizing those principles and moving us forward. As stated by James Beckerman, MD, FACC, Team Cardiologist for Portland Timbers MLS and director of Play Smart Youth Heart Screenings, the publication “communicates to the wider community of physicians about the specific and unique issues related to the care of athletes and the need for more resources from a research perspective and more input from academic colleagues to establish best practices in conjunction with clinical cardiologists in the community and the sports field to continue to mold our practices for tomorrow.”

This post is part of a series of posts from the ACC’s Sports and Exercise Cardiology Section. For more information about the Section, click here.  

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