Abstract 17327: Heterogenous Shared Decision-Making Approaches to Sports Eligibility Decisions for Athletes With Cardiovascular Disease

Abstract

Background: Historically, almost all pathologic cardiovascular (CV) diagnoses led to complete restriction from competitive sports. In 2015, the American College of Cardiology (ACC) and American Heart Association began to embrace a more nuanced, patient-centered approach to sports eligibility using shared decision-making (SDM). While SDM is a conceptually defensible approach to sports eligibility, operationalization is complex, and we know very little about how physicians understand and deploy it. Methods: To assess sports cardiologists’ understandings of SDM and approaches to eligibility decisions, in-depth interactive interviews were conducted with (N=20) self-identified sports cardiologists. Participants were sampled at random from the ACC Sports and Exercise Cardiology Section. Interviews were conducted using video conference or telephone, and transcripts were analyzed for qualitative description of key domains. Results: Analysis revealed heterogeneity regarding core elements of SDM. All 20 clinicians endorsed SDM, but conceptions of what SDM means varied. Some emphasized communication between physicians rather than with patients, and there was variation in describing the clinician’s role primarily as a provider of information or a more active driver of the decision. Furthermore, even though lifestyle considerations are a key component of SDM for sports eligibility, few clinicians (n=6) specifically referenced elicitation of a patient’s preferences as part of the SDM process. Clinicians also stated highly variable thresholds for prohibitive annual risk of sudden cardiac death during sports participation ranging from <1% to >10%, and they expressed heterogenous views of how athletes interpret risk. Some believed athletes can interpret risk in similar ways as other people; others felt they are largely blind to risk. Conclusions: These data collectively demonstrate heterogenous views of and approaches to SDM for sports eligibility decisions that likely result in very different encounters and decision outcomes. There is a need to develop a more robust understanding of how SDM is operationalized in this context and determine an evidence-based approach to SDM for sports and exercise eligibility in the context of CV disease.