Abstract 13797: Routes and Barriers to Return to Play in Athletes With Cardiac Disease

BackgroundRecommendations for return to play for athletes with cardiovascular disease have evolved from an initially conservative approach to more flexible decision making, but the implications for patient-athletes is unknown. This study was designed to examine routes to returning to play and identify the barriers these athletes encountered.MethodsA mixed methods telephone survey combining quantitative and qualitative components was administered to 28 patients identified from the Yale ICD Sports registry and Mayo Clinic’s Inherited Disease clinic. Qualitative data was analyzed with a coding scheme to identify common themes.ResultsDiagnoses were long QT syndrome(n=11), hypertrophic cardiomyopathy (n=5), CPVT (N=3), congenital (n=3), Brugada (n=1), ARVD (n=1), LV non-compaction (n=1), unknown (n=3). Twenty-one had an ICD and 11 had a history of arrest. The most prevalent sports included soccer (n=8), basketball (n=6), and football (n=4). The highest level of participation was semi-professional (n=3), college varsity (n=10), college club (n=3), and high school (n=10). During the process patients saw an average of 2.7 physicians and a maximum of 7 physicians. 21 patients encountered barrier(s)17 could not participate per their first cardiologist; 6 met with school administrators, 2 met with social workers/counselors, 4 signed waivers, and 3 hired lawyers. Two patients changed schools and 4 were unable to participate at their intended level (collegiate or semi-professional) and/or had scholarships revoked. Many (43%) felt that communication between all parties (patients, physicians, school administrators) could be improved, and the cardiologist’s lack of familiarity with the diagnosis was a major barrier. A common theme was cynicism regarding the school’s concern for liability rather than the patient’s well-being.ConclusionsMany barriers exist for athletes with cardiac disease who wish to return to play. Challenges in communication and the lack of physician familiarity has delayed their participation. While recommendations regarding competitive sports participation for such athletes have changed, adoption has lagged. Shared decision-making is critical for return to play for athletes with cardiovascular disease.