Despite the documented health benefits of physical exercise, there is a paradoxical, but small, risk of sudden cardiac arrest (SCA) and/or death (SCD) associated with exercise. Cardiovascular causes account for 75% of sportrelated deaths in young athletes, with SCA/SCD rates varying according to athlete age, gender, intensity of activity, race, and ethnicity. True risk for American athletes is dif fi cult to assess owing to the lack of a national registry with well-de fi ned numerators and denominators, and a consensus on metrics. Although exercise-related syncope and/or chest pain are considered the most ominous prodromal complaints, the true predictive value of symptoms is not known in athletic populations. The comparative effectiveness of various screening methodologies (e.g. history and physical alone versus history and physical plus electrocardiogram) with regard to athlete outcomes has not been determined. To address these issues in American athletes, and to coordinate a nation-wide multidisciplinary approach to athlete cardiovascular care, the American College of Cardiology Sports and Exercise Cardiology Section convened the " Think Tank to Protect the Heart of the American Athlete and Exercising Individual " on October 18, 2012, in Washington, DC. Think Tank participants (representing athletic trainers; primary care professional societies; cardiovascular specialty, subspecialty, and imaging societies; government agencies; industry; sports governing bodies; and patient advocacy groups) identifi ed 92 quality gaps, and created an action plan to address the most urgent of these gaps: 1) Defining sports cardiology outcome metrics and conducting highquality epidemiologic research; 2) Educating providers in the optimal use of existing clinical athlete cardiovascular care tools; 3) Promoting and conducting research to de fi ne normative values for cardiac tests in large numbers of American athletes and developing datadriven management algorithms; and 4) Coordinating athlete advocacy efforts by creating athlete cardiovascular care state-wide task forces. The Think Tank plans to convene every 2 years to monitor progress.
Bibliographical noteFunding Information:
Committee Member Employment Consultant Speakers Bureau Ownership/Partnership/ Principal Personal Research Institutional, Organizational, or Other Financial Benefit Expert Witness Christine E. Lawless Sports Cardiology Consultants, President None None None None None None Chad Asplund Eisenhower Army Medical Center–Director, Military Sports Medicine None None None None None None Irfan M. Asif University of Tennessee Family and Sports Medicine—Assistant Professor; Fellowship Director, Sports Medicine None None None None None None Ron Courson University of Georgia—Senior Associate Athletic Director None None None None None None Michael S. Emery Carolina Cardiology Consultants None None None None None None Anthon R, Fuisz Medstar Washington Hospital Center–Director, Cardiac MRI None None None None None None Richard J. Kovacs Krannert Institute of Cardiology–Professor of Clinical Medicine • Biomedical Systems • Insight Pharmaceuticals • Theravance † • Xenoport None None • Biotie (DSMB) • Eli Lilly (DSMB) † • Cook Incorporated Med Institute † None Silvana M. Lawrence Baylor College of Medicine—Associate Professor, Department of Pediatrics, Section of Cardiology None None None None None None Benjamin D. Levine Institute for Exercise and Environmental Medicine None None None None None • Defendant, 2013, Postural Orthostatic Tachycardia Syndrome Mark S. Link Tufts Medical Center None None None None None None Matthew W. Martinez Lehigh Valley Health Network None None None None None None G. Paul Matherne University of Virginia Health Sciences Center–Division Chief of Pediatric Cardiology None None None None None None Brian Olshansky University of Iowa Hospitals–Professor of Medicine • Arrhythmia Grand Rounds ∗ • BioControl • Boehringer Ingleheim • Boston Scientific (guidant) • Combined Medicare Medicaid Services • Daiichi Sankyo • Gerson Lehman • Medtronic † • Sanofi Aventis None None • Amarin (DSMB) • Boston Scientific (DSMB) • Sanofi Aventis (DSMB) • Boston Scientific • Executive Health Resources † • Thompson Reuters ∗ • Defendant, 2013 Event Monitors • Third Party, 2012, Cardiac Arrest William O. Roberts University of Minnesota Medical School–Professor, Department of Family Medicine and Community Health None None None None None None Lisa Salberg Hypertrophic Cardiomyopathy Association–Chief Executive Officer None None None None None None Victoria L. Vetter Children’s Hospital of Philadelphia Division of Cardiology–Professor of Pediatrics None None None None None None Robert A. Vogel University of Colorado–Professor of Medicine • Pritikin Longevity Center • National Football League † None None • Sanofi † None None Jim Whitehead American College of Sports Medicine–Executive Vice President/Chief Executive Officer This table represents all relationships of committee members with industry and other entities that were reported by authors, including those not deemed to be relevant to this document, at the time this document was under development. The table does not necessarily reflect relationships with industry at the time of publication. A person is deemed to have a significant interest in a business if the interest represents ownership of ≥5% of the voting stock or share of the business entity, or ownership of ≥$10,000 of the fair market value of the business entity; or if funds received by the person from the business entity exceed 5% of the person’s gross income for the previous year. Relationships that exist with no financial benefit are also included for the purpose of transparency. Relationships in this table are modest unless otherwise noted. Please refer to http://www.cardiosource.org/Science-And-Quality/Practice-Guidelines-and-Quality-Standards/Relationships-With-Industry-Policy.aspx for definitions of disclosure categories or additional information about the ACC/AHA Disclosure Policy for Writing Committees. ∗ No financial benefit. † Indicates significant relationship. Appendix 2
© 2014 by the American College of Cardiology Foundation.