Empowerment of Athletes With Cardiac Disorders: A new Paradigm

Rui Providencia; Carina Teixeira; Oliver R. Segal; Augustus Ullstein; Kim Mueser; Pier D. Lambiase

Disclosures

Europace. 2018;20(8):1243-1251. 

In This Article

Abstract and Introduction

Abstract

Athletes with cardiac disorders frequently pose an ethical and medical dilemma to physicians assessing their eligibility to participate in sport. In recent decades, patient empowerment has been gaining increasing recognition in clinical decision-making. Empowerment is a process through which people are involved over the decisions and actions that affect their own lives. In the context of a cardiac disorder, empowerment means giving an athlete the chance to participate in the decision about whether or not to remain active in competition. Three models of treatment decision-making are described in this article, with progressive levels of empowerment: the paternalistic model (the athlete has a passive role), the shared-decision making model (both athlete and physician participate in the decision), and the informed-decision making (the decision is made by the athlete while the role of the physician is solely to provide information). This article critically discusses the issues involved in disqualification of athletes with cardiovascular disorders and suggests possible ways of incorporating patient empowerment in potentially career-ending decisions. The authors propose a model of empowerment, which gives patients the opportunity to choose how much, and if, they would like to be involved in the decision-making process.

Introduction

The diagnosis of a cardiovascular disorder in a competitive athlete very frequently leads to the discontinuation of their sporting career due to concerns of disease progression and exercise-induced sudden cardiac death (SCD).[1] However, potential career-ending decisions are complex, associated with medical, ethical, and legal challenges,[2] and may result in significant psycho-social and economic adverse consequences for the athlete.[3]

In recent decades, patient empowerment has been gaining increasing momentum in clinical decision-making.[4] In this article, we consider the issue of athletic disqualification in the full spectrum of cardiovascular disease, including cardiomyopathies, channelopathies, congenital heart disease, valvular heart disease, among others. Three subgroups of patients deserve additional considerations, besides the scope of this article. Firstly, patients with structural conditions such as aortic stenosis, congenital coronary malformations, and aortic aneurysms, due to their specific requirements, namely timely diagnosis and appropriate surgical correction. Secondly, patients with coronary artery disease as emphasis should be put on optimization of drug therapy, control of risk factors, and percutaneous or surgical revascularization. Lastly, athletes aged less than 18 years pose specific challenges as they may not have the maturity or experience to weigh up these complex issues, they are subject to specific legal restrictions, and legal guardians should be involved in the decision-process.[5]

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