New recommendations green-light some athletes with heart disease to compete in competitive sport

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Recommendations from the American Heart Association and the American College of Cardiology may permit participation in competitive sports for some athletes with long QT syndrome. The recommendations were published in both Circulation and the Journal of the American College of Cardiology.

The new recommendations apply only to athletes with diagnosed heart disease who participate in competitive level sports directed by a coach (ie. football, basketball, baseball and others). They do not apply to those who occasionally participate in sports for fun or exercise.

New medical research indicates, however, that the risk of sudden cardiac arrest is lower than previously thought for these patients.

To calculate the risk of sudden cardiac arrest, an expert panel at the American Heart Association and the American College of Cardiology analysed detailed medical reports on competitive athletes with different types of heart disease. In addition to irregular heartbeat, these diseases include heart-valve damage, high blood pressure, and narrowing of the blood vessels, among many others.

The new research shows, too, a lower risk of sudden cardiac arrest among some competitive athletes with some types of heartbeat disorders treated by pacemakers and ICDs. Under the new recommendations, some of these athletes now may be able to compete – with their healthcare provider’s approval, since every patient is different.

“These recommendations are not intended to establish absolute mandates or to make the general medical (and legal) standard of care applicable to all competitive athletes,” says Barry Maron, co-chair of the writing committee and director of the Hypertrophic Cardiomyopathy Center at the Minneapolis Heart Institute Foundation, USA.

“It should be noted that the guidance for patients with hypertrophic cardiomyopathy has not changed – we still recommend avoiding intense competitive sports for people who have this condition,” Maron says.

“The ultimate incentive is to prevent sudden cardiac death in the young, although it is also important not to unfairly or unnecessarily remove individuals from a healthy athletic lifestyle,” says Douglas P Zipes, co-chair of the statement writing group and professor at Indiana University School of Medicine, Krannert Institute of Cardiology in Indianapolis, USA.

The scientific statement also provides recommendations for evaluating other congenital,genetic and acquired cardiac conditions that could increase the risk of sudden cardiac arrest among competitive athletes, as well as emphasising the importance of avoiding performance-enhancing drugs which also increase risk. The statement notes it is also critical for competitive athletes and their coaches to learn how to use an automated external defibrillator.

“The panel recognises and strongly supports the well-documented health benefits of exercise, with regular physical activities encouraged for those individuals who have been removed from organised competitive athletics,” Zipes says.

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