Eligibility and Disqualification Recommendations for Competitive Athletes With Cardiovascular Abnormalities: Preamble, Principles, and General Considerations: A Scientific Statement From the American Heart Association and American College of Cardiology.

Abstract

This document addresses medical issues related to trained athletes with cardiovascular abnormalities. The objective is to present, in a readily useable format, consensus recommendations and guidelines principally addressing criteria for eligibility and disqualification from organized competitive sports for the purpose of ensuring the health and safety of young athletes. Recognizing certain medical risks imposed on athletes with cardiovascular disease, it is our aspiration that the recommendations that constitute this document will serve as a useful guide to the practicing community for clinical decision making. The ultimate goal is prevention of sudden death in the young, although it is also important not to unfairly or unnecessarily remove people from a healthy athletic lifestyle or competitive sports (that may be physiologically and psychologically intertwined with good quality of life and medical well-being) because of fear of litigation. It is our goal that the recommendations in this document, together with sound clinical judgment, will lead to a healthier, safer playing field for young competitive athletes. There have been 3 prior documents, all sponsored by the American College of Cardiology (ACC),1–3 that addressed eligibility and disqualification criteria for competitive athletes with cardiovascular diseases: Bethesda Conferences 16 (1985), 26 (1994), and 36 (2005), published and used over a 30-year period. Each of the 3 initiatives (and the present American Heart Association (AHA)/ACC scientific statement) were driven by the tenet that young trained athletes with underlying cardiovascular abnormalities are likely at some increase in risk for sudden cardiac death (usually on the athletic field) compared to nonathletes or competitive athletes without cardiovascular disease.4–8 All 3 Bethesda Conferences and the present derived AHA/ACC document provide expert consensus recommendations. These insights use (1) the experience and expertise of the panelists (ie, individual and collective judgments, using the “art of medicine”) and (2) …