Heart Health: Guidance for Athletes to Return to Play Following COVID-19 Diagnosis

By Sherri Middleton, Executive Editor

When can athletes who have had COVID-19 safely return to play?

A team of medical professionals in cardiology, sports, and exercise recently published a perspective about heart injuries in patients following a COVID-19 diagnosis.

According to Dr. Dermot Phelan, M.D., Ph.D., Sports Cardiology, Hypertrophic Cardiomyopathy Program at Sanger Heart and Vascular Institute at Atrium Health in Charlotte, N.C., sporting organizations, including major league sports, colleges, amateur athletics and others involved in sports programs in the United States reached out for guidance about the safety of allowing athletes to return to sports after suffering from Coronavirus and COVID-19.

The guidance was published in the Journal of the American Medical Association Cardiology (JAMA Cardiology) last week by Dr. Phelan and his peers, Dr. Jonathan H. Kim, M.D., MSc, Sports Cardiology, Emory School of Medicine at Emory Clinical Cardiovascular Research Institute in Atlanta, Ga., and Eugene H. Chung, MD., MSc, Cardiac Electrophysiology Service, Sports Cardiology Clinic, Michigan Medicine at the University of Michigan Ann Arbor.

“We know from studies evaluating hospitalized patients diagnosed with COVID-19 that the frequency of heart problems is 7 to 33 percent,” Dr. Phelan said. “What we don’t know is how many people who have suffered from COVID-19 but were not hospitalized, actually had a cardiac injury,” he said.

Video Interview Clips with Dr. Phelan

The recommendations, when exposed to COVID and recovered completely from the illness is to avoid exercise. Phelan and his peers recommend that athletes rest for two weeks once symptoms resolve from the viral COVID-19 infection.

In athletes who have been symptomatic, Phelan, Kim, and Chung recommend evaluation for cardiac involvement after the two weeks of rest. Follow-up evaluations would include a blood test, electrocardiogram (EKG) and an echocardiogram to determine whether a cardiac injury has occurred.

“Patients need to be evaluated closely by a cardiologist,” Phelan said. “The concern is that if the athlete has myocarditis – a condition where the virus invades the heart muscle – exercise will increase viral replication and increase the damage to the heart potentially leading to dangerous abnormal heart rhythms and even death. It’s a serious issue and not to be taken lightly.” Athletes with high suspicion for myocarditis after testing will be restricted from exercise for 3-6 months and will require extensive repeat testing including stress testing, rhythm monitoring and echocardiography prior to return to play

Phelan said even athletes who have not been hospitalized with COVID-19 but have reported symptoms such as a loss of smell or taste and respiratory symptoms known with the virus should assume, they may have had the viral disease.

Dr. Phelan established and ran the Sports Cardiology Center at the Cleveland Clinic for eight years before moving to North Carolina. He serves as the Cardiology Consultant to the National Football League Scouting Combine, and he is a member of the Cardiac Screening Advisory Committee for the National Basketball Association, in addition to serving as a consultant to multiple other professional and amateur sporting organizations.

“Antibody testing will become more widely available, and it should be available to everyone at some point, but for now, we are focusing on athletes who are returning to play after COVID-19,” Dr. Phelan said. “Athletes and others who are more social and who exercise in gyms and facilities must also be aware of the dangers of injuries to the heart. More data will be collected, and we will change these recommendations if necessary, but for now, we are warning athletes and their coaches to be cautious and follow the guidelines of a cardiologist.”

For athletes who remain asymptomatic and test negative for COVID-19, return to exercise and training is allowed without additional testing. Asymptomatic athletes who test positive for COVID-19 antigen should refrain from exercise for at least two weeks from the date of positive test results and follow strict isolation guidelines. Slow resumption of activity is recommended for asymptomatic individuals.

Dr. Phelan also suggested that everyone, including athletes, continue to follow the Centers for Disease Control and Prevention (CDC) guidelines, continue to practice social distancing, and heed warnings from state and local officials about returning to social activities.

Click here for the full JAMA Cardiology Report.

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