PREV

EP

CHRS

EDUCATION

Workshop

SHARED DECISION MAKING IS THE NEW PARADIGM TOWARDS SCREENING AND CARE OF THE ATHLETE: A CASE BASED TRANSLATION OF THE CCS/CHRS JOINT POSITION STATEMENT

Co-Chair(s)

• 

  Amer Johri, MD, MSc, FRCPC, FASE

  Associate Professor
  Queen's University
  Queen's University
• James M.

  James McKinney, MD FRCPC

  Clinical Assistant Professor

Planning Committee Member(s)

• Paul P.

  Paul Poirier, MD, PhD

  Chief prevention cardiology
  IUCPQ
  Universite Laval
• 

  François Philippon, MD, FRCPC, FHRS, FCCS

  Cardiologist
  IUCPQ
  Laval University
• 

  Nicholas Grubic, BScH, MSc (Candidate 2021)

  Graduate Student
  Queen's University
  Queen's University
• 

  Margaret Robin Cases, MD

  Community-based Physician
  Kingston Heart Clinic

The Shared Decision Making Approach (SDM) represents a paradigm shift in clinical management, acknowledging the complexities and uncertainties in clinical medicine, while respecting the personal values and preferences of an informed, individual patient. The SDM approach is highly suitable to the screening and management of athletes, given the variable evidence, uncertainty as to best practices, and consequences related to sports participation/restriction. The CCS Sport Group recently published Canada’s first recommendations for the Cardiovascular Screening and Care of the Athlete Program. This Joint Position Statement by the CCS and CHRS is globally unique in its detailed description of the SDM process, including provision of: Choice Awareness, Options Dialogue, and the Decision Discussion. This workshop does the critical task of disseminating this recommended standard of care for the cardiovascular health of Canadian athletes. The Position Statement calls for a systematic approach to screening, emphasizing appropriate screening assessment, investigations, and interpretation, in addition to management, counselling and follow-up. It outlines how institutions should employ a stepwise approach to athletic cardiovascular care, where a foundation of high-quality emergency protocols, access to sports cardiology expertise, and a SDM approach are required, prior to the addition of three screening tiers, including a history questionnaire, physical examination, and electrocardiogram. The SDM approach underpins the program described as it is the basis for non-binary discussion with respect to the impact of cardiovascular abnormalities and devices upon participation, restriction, or return-to-play.

Currently there is a lack of training in the area of sports cardiology provided to both cardiology residents and trainees of other disciplines involved in the cardiovascular care of athletes. Overall, Canadian health professionals, particularly those working with athletes, must be informed and educated on how to effectively screen for cardiac conditions, harnessing the expertise of their collaborative partners to create a multi-disciplinary cardiovascular care team. With sudden cardiac death (SCD) as the leading medical cause of death among competitive athletes, increased knowledge of sports cardiology is essential to ensure the health and safety of athletes across Canada.

The focus of this workshop is to disseminate the SDM as detailed in the CCS/CHRS Joint Position Statement to educate health professionals on the identification and management of at-risk athletes, particularly those with abnormalities relating to SCD, using a non-binary approach. Each presenter will provide cases illustrating the assessment and management of athletes with clinically significant conditions, particularly hypertrophic cardiomyopathy, arrhythmia, and coronary anomalies. The workshop is endorsed by CHRS.

 

Learning Objectives

At the conclusion of this session, participants will be able to:

• translate the practice recommendations from the recently published CCS/CHRS Joint Position Statement on the cardiovascular screening of competitive athletes, allowing them to initiate a pre-participation screening program (Cardiovascular Screening and Care of the Athlete Program) at their home institution;
• identify 'Red Flags' associated with hypertrophic cardiomyopathy, arrhythmia, and coronary anomalies in athletes, as well as manage and monitor athletes with implantable cardioverter-defibrillators, ensuring these athletes are safe in their participation in high-intensity and/or endurance sport; and
• utilize novel concepts and experimental work associated with the non-binary shared-decision making approach to athletic cardiovascular screening in a practical clinical setting, particularly relating to sports participation, restriction, and/or return-to-play decisions.

Presentations:

• 9:00 AM - 9:10 AM

  INTRODUCTION OF SHARED DECISION MAKING FROM THE CHRS/CCS POSITION STATEMENT
  Nathaniel Moulson
• 9:10 AM - 9:25 AM

  EXAMPLE OF SHARED DECISION MAKING EP CASE
  Paul Dorian, MD MSc – Division of Cardiology, University of Toronto
• 9:25 AM - 9:35 AM

  CASES IN PEDIATRICS
  Anne Fournier, MD, FRCPC, FCCS – CHU mere-enfant Sainte-Justine
• 9:35 AM - 9:45 AM

  THE PERSPECTIVE FROM A VARSITY COMPETITIVE ATHLETE WHO UNDERWENT SCREENING
  Nicholas Grubic, BScH, MSc (Candidate 2021) – Queen's University
• 9:45 AM - 10:00 AM

  DISCUSSION