Comparing Guidelines on Participation in Competitive Sports by Patients with Congenital Heart Disease

Experts from the Heart Institute at UPMC Children’s Hospital of Pittsburgh recently published new research regarding participation in competitive sports by patients with congenital heart disease (CHD) in the Journal of the American College of Cardiology.

Tarek Alsaied, MD, MSc, associate professor of Pediatrics, was the senior author of the study. Also contributing to the research was Jacqueline Kreutzer, MD, Heart Institute co-director and division chief of Pediatric Cardiology.

This publication summarizes and compares guidelines from the American Heart Association/American College of Cardiology (AHA/ACC) with guidelines from the European Association of Preventative Cardiology/European Society of Cardiology/Association for European Paediatric and Congenital Cardiology (EAPC/ESC/AEPC) on participation in competitive sports by patients with CHD.

The review aims to assist cardiologists in synthesizing published research and data when counseling patients on sports participation. As research and medicine progress, doctors are able to provide better care and outcomes to patients with CHD. With improved care, more patients with complex cases are entering adulthood with higher physical capacity, making sports participation an important topic to discuss.

Conclusion of Findings

While both sets of guidelines from the AHA/ACC and the EAPC/ESC/AEPC recognize the importance of exercise for patients with CHD, they diverge in terms of approach to recommendation on sports participation. The EAPC/ESC/AEPC guidelines promote personalized recommendations based on patient specific hemodynamic and electrophysiological parameters and place less emphasis on anatomy. In contrast, the AHA/ACC guidelines allow for greater provider discretion and focus on underlying anatomy to determine sports participation. Recommendations are based on each patient’s specific anatomical defect.

Both sets of guidelines share the need for expert opinion, but there is a lack of evidence to support one set versus the other. More research is needed for data-driven recommendations. Generating reliable data through a multicenter, international study would allow for the development of one unified set of guidelines incorporating both viewpoints. Without reliable data, researchers highlight the importance of the patient and their family playing an active role in the decision-making process with their doctor.

Until comprehensive, evidence-based guidelines for sports participation in CHD patients are available, cardiologists should prioritize individualized assessments tailored to each patient's unique condition. Engaging in shared decision-making with patients and their families, employing a multidisciplinary health care approach, and ensuring regular monitoring can optimize safety. Educating both patients and sports personnel about potential risks and safety measures is crucial.

Reference

Kamel Shibbani, Ali Abdulkarim, Werner Budts, Jolien Roos-Hesselink, Jan Müller, Keri Shafer, Prashob Porayette, Ali Zaidi, Jacqueline Kreutzer, Tarek Alsaied, Participation in Competitive Sports by Patients With Congenital Heart Disease: AHA/ACC and EAPC/ESC/AEPC Guidelines Comparison, Journal of American College of Cardiology, 2024, 83(7):772-782. https://doi.org/10.1016/j.jacc.2023.10.037. PMID: 38355248.