A robust action plan with specific strategies and methods to address gaps in the cardiovascular care of athletes was published Oct. 8 in the Journal of the American College of Cardiology. 

The report is based on findings and recommendations from an ACC Sports and Exercise Cardiology Section think tank that convened in 2012 to coordinate a nation-wide multidisciplinary approach for the cardiovascular care of athletes. Specifically, the think tank identified 92 quality gaps within four main categories: 1) defining sports cardiology outcome metrics and conducting high-quality epidemiologic research; 2) educating providers in the optimal use of existing clinical athlete cardiovascular care tools; 3) promoting and conducting research to define normative values for cardiac tests in large populations of American athletes and developing data-driven management algorithms; and 4) coordinating athlete advocacy efforts by creating athlete cardiovascular care state-wide task forces.

According to the report, definitive cardiovascular risks to athletes are not known because large, prospective, longitudinal cohorts studies have not been conducted in young athletic populations with suspected low prevalence of disease, using well-defined, consensus-derived metrics. Once these metrics have been defined, prospective athlete outcomes registries must be designed that are sports-specific and level-specific, and that take into account athlete heterogeneity.

Immediate steps towards better education including recognizing sudden cardiac arrest and its warning signs, and the optimal implementation of AEDs in schools and athletic venues are recommended. Beyond the promotion of existing clinical tools, the report encourages the development of core competencies in sports and exercise cardiology and the inclusion of basic sport health competencies and certifications.

The need for rigorous research and meaningful data is also recognized. Areas in need of immediate attention include the uncertain predictive value of symptoms; the lack of an evidence base for the traditional participation guidelines; major evidence holes in the ongoing ECG screening debate; and the lack of normative data in large populations of American athletes of varying age, gender, race, ethnicity, size, and sport. Moving forward, the authors note that the sports cardiology community should promote and conduct research that develops data-driven management algorithms, examines predictive value of symptoms in athletes, and aligns data among disparate groups.

Finally, in an effort to coordinate advocacy efforts, the authors recommend the creation of a coalition of national American professional groups working in collaboration to create uniform standards and present a consistent, unified message to the community at large. The creation of state-wide, athlete cardiovascular care task forces were additionally proposed.

“The think tank represented a remarkable achievement to bring together varied stake holders across multiple organizations and scientific disciplines with a singular goal: ‘Protecting the Heart of the American Athlete,’” said Michael S. Emery, MD, FACC, co-author of the report and co-chair of the ACC’s Sports and Exercise Cardiology Section Leadership Council. “The publication of the proceedings now sets into motion action plans to move forward with research, advocacy and education to help address the gaps identified and ultimately lead to better cardiovascular evaluation and care of the athlete.”

Keywords: Cooperative Behavior, Algorithms, Athletes, Exercise, Sports, Risk Factors, Electrocardiography, Consensus, Prevalence, Registries, Certification, United States, Physical Examination, Death, Sudden, Cardiac