As critical data to advance the understanding of COVID-19 outcomes in athletes is currently being collected, thoroughly rehearsed emergency action planning represents the best strategy to save lives, according to a paper published Oct. 26 in JAMA Cardiology.

Jonathan H. Kim, MD, MSc, FACC, member of ACC’s Sports and Exercise Cardiology Section Leadership Council, et al., address the most common questions regarding COVID-19 and cardiac pathology in athletes in competitive sports, including the extension of return-to-play considerations to discrete populations of athletes not addressed in prior recommendations. In the absence of definitive data, the authors explain that there is ongoing uncertainty about the optimal approach to cardiovascular risk stratification of athletes in competitive sports following COVID-19 infection.

Of note, the paper provides insights from recent COVID-19 cardiac magnetic resonance imaging data. According to the authors, emerging observational data coupled with widely publicized reports of athletes in competitive sports with reported COVID-19-associated cardiac pathology suggest that myocardial injury may occur in cases of COVID-19 that are asymptomatic and of mild severity.

At present, there authors explain that there is a shared focus in the sports medicine and cardiology communities to define the prevalence of clinically significant cardiac injury in athletes infected with COVID-19 and determine the efficacy of current consensus-based cardiovascular risk stratification practices. They add that prospective acquisition of comprehensive large-scale registry data at the collegiate and professional levels, as well as surveillance for adverse clinical outcomes, will be required to address these areas of uncertainty.

"To proceed safely with sports during the COVID-19 pandemic, the critical pieces on which we must focus have not changed," the authors conclude. "An emphasis on public health, suppression of viral spread, increased access to testing and ultimately vaccination should all be prioritized."

In an accompanying editorial comment, James E. Udelson, MD, FACC, et al., note that "as we move forward, it is clear that clinicians and practitioners must remain vigilant in their care despite even mild severity of initial symptom presentation." They add, "it is critical that measures to reduce the prevalence of COVID-19 infection are in place, so that athletes ultimately do not have to engage in this process as the world returns to sports."

Clinical Topics: Cardiovascular Care Team, COVID-19 Hub, Sports and Exercise Cardiology

Keywords: COVID-19, Prevalence, Consensus, Uncertainty, Public Health, Leadership, Cardiovascular Diseases, Prospective Studies, severe acute respiratory syndrome coronavirus 2, Risk Factors, Sports, Sports Medicine, Athletes

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