2024 AHA/ACC/AMSSM/HRS/PACES/SCMR Guideline for the Management of Hypertrophic Cardiomyopathy: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines.

AIM: The "2024 AHA/ACC/AMSSM/HRS/PACES/SCMR Guideline for the Management of Hypertrophic Cardiomyopathy" provides recommendations to guide clinicians in the management of patients with hypertrophic cardiomyopathy. METHODS: A comprehensive literature search was conducted from September 14, 2022, to November 22, 2022, encompassing studies, reviews, and other evidence on human subjects that were published in English from PubMed, EMBASE, the Cochrane Library, the Agency for Healthcare Research and Quality, and other selected databases relevant to this guideline. Additional relevant studies, published through May 23, 2023, during the guideline writing process, were also considered by the writing committee and added to the evidence tables, where appropriate. STRUCTURE: Hypertrophic cardiomyopathy remains a common genetic heart disease reported in populations globally. Recommendations from the "2020 AHA/ACC Guideline for the Diagnosis and Treatment of Patients With Hypertrophic Cardiomyopathy" have been updated with new evidence to guide clinicians.

2024 AHA/ACC/AMSSM/HRS/PACES/SCMR Guideline for the Management of Hypertrophic Cardiomyopathy: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines.

AIM: The "2024 AHA/ACC/AMSSM/HRS/PACES/SCMR Guideline for the Management of Hypertrophic Cardiomyopathy" provides recommendations to guide clinicians in the management of patients with hypertrophic cardiomyopathy. METHODS: A comprehensive literature search was conducted from September 14, 2022, to November 22, 2022, encompassing studies, reviews, and other evidence on human subjects that were published in English from PubMed, EMBASE, the Cochrane Library, the Agency for Healthcare Research and Quality, and other selected databases relevant to this guideline. Additional relevant studies, published through May 23, 2023, during the guideline writing process, were also considered by the writing committee and added to the evidence tables, where appropriate. STRUCTURE: Hypertrophic cardiomyopathy remains a common genetic heart disease reported in populations globally. Recommendations from the "2020 AHA/ACC Guideline for the Diagnosis and Treatment of Patients With Hypertrophic Cardiomyopathy" have been updated with new evidence to guide clinicians.

Using artificial intelligence for exercise prescription in personalised health promotion: A critical evaluation of OpenAI's GPT-4 model.

The rise of artificial intelligence (AI) applications in healthcare provides new possibilities for personalized health management. AI-based fitness applications are becoming more common, facilitating the opportunity for individualised exercise prescription. However, the use of AI carries the risk of inadequate expert supervision, and the efficacy and validity of such applications have not been thoroughly investigated, particularly in the context of diverse health conditions. The aim of the study was to critically assess the efficacy of exercise prescriptions generated by OpenAI's Generative Pre-Trained Transformer 4 (GPT-4) model for five example patient profiles with diverse health conditions and fitness goals. Our focus was to assess the model's ability to generate exercise prescriptions based on a singular, initial interaction, akin to a typical user experience. The evaluation was conducted by leading experts in the field of exercise prescription. Five distinct scenarios were formulated, each representing a hypothetical individual with a specific health condition and fitness objective. Upon receiving details of each individual, the GPT-4 model was tasked with generating a 30-day exercise program. These AI-derived exercise programs were subsequently subjected to a thorough evaluation by experts in exercise prescription. The evaluation encompassed adherence to established principles of frequency, intensity, time, and exercise type; integration of perceived exertion levels; consideration for medication intake and the respective medical condition; and the extent of program individualization tailored to each hypothetical profile. The AI model could create general safety-conscious exercise programs for various scenarios. However, the AI-generated exercise prescriptions lacked precision in addressing individual health conditions and goals, often prioritizing excessive safety over the effectiveness of training. The AI-based approach aimed to ensure patient improvement through gradual increases in training load and intensity, but the model's potential to fine-tune its recommendations through ongoing interaction was not fully satisfying. AI technologies, in their current state, can serve as supplemental tools in exercise prescription, particularly in enhancing accessibility for individuals unable to access, often costly, professional advice. However, AI technologies are not yet recommended as a substitute for personalized, progressive, and health condition-specific prescriptions provided by healthcare and fitness professionals. Further research is needed to explore more interactive use of AI models and integration of real-time physiological feedback.

Focus areas and methodological characteristics of North American-based health disparity research in sports medicine: a scoping review.

OBJECTIVE: Health disparities are widely prevalent; however, little has been done to examine and address their causes and effects in sports and exercise medicine (SEM). We aimed to summarise the focus areas and methodology used for existing North American health disparity research in SEM and to identify gaps in the evidence base. DESIGN: Scoping review. DATA SOURCES: Systematic literature search of PubMed, Scopus, SPORTDiscus, CINAHL Plus with Full Text, Web of Science Core Collection and Cochrane Central Register of Controlled Trials. ELIGIBILITY CRITERIA: Full-text, peer-reviewed manuscripts of primary research, conducted in North America; published in the year 2000 or after, in English; and focusing on organised sports were included. RESULTS: 103 articles met inclusion criteria. Articles were classified into five focus areas: access to and participation in sports (n=45), access to SEM care (n=28), health-related outcomes in SEM (n=24), provider representation in SEM (n=5) and methodology (n=1). Race/ethnicity (n=39), socioeconomic status (n=28) and sex (n=27) were the most studied potential causes of health disparities, whereas sexual orientation (n=5), location (rural/urban/suburban, n=5), education level (n=5), body composition (n=5), gender identity (n=4) and language (n=2) were the least studied. Most articles (n=74) were cross-sectional, conducted on youth (n=55) and originated in the USA (n=90). CONCLUSION: Health disparity research relevant to SEM in North America is limited. The overall volume and breadth of research required to identify patterns in a heterogeneous sports landscape, which can then be used to inform positive change, need expansion. Intentional research focused on assessing the intersectionality, causes and consequences of health disparities in SEM is necessary.

International study of physicians' opinion on physician-patient sex concordance when treating athletes.

BACKGROUND: The effect of physician-patient sex concordance in medicine has been reported in many studies. Whether physicians believe that the sex concordance between physician and athlete influences treatment has not been investigated. OBJECTIVE: To determine whether physicians believe that the sex concordance between physician and athlete influences treatment. DESIGN: Cross-sectional study. SETTING: Online survey. PARTICIPANTS: One thousand one hundred ninety-three sports medicine physicians in 51 countries. Participants were sports medicine physicians trained in orthopedics (n = 443 [37.1%]) and nonorthopedics (n = 750 [62.9%]). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Participants were asked to decide whether sex of the physician made them better suited to care for athletes of concordant or different sexes along with their personal background. RESULTS: Orthopedic sports medicine physicians agreed less than nonorthopedic sports medicine physicians regarding the statement "MALE sports medicine physicians are better suited than their female counterparts to care for MALE athletes" (odds ratio [OR] 0.56, 95% confidence interval [CI] 0.35-0.91, p = .02), and compared to sports medicine physicians based in Europe, those based in Asia agreed more to this statement (OR 7.91, 95% CI 4.60-13.60, p < .01). In addition, regarding the statement "FEMALE sports medicine physicians are better suited than their male counterparts to care for FEMALE athletes," compared to sports medicine physicians based in Europe, those based in Asia (OR 9.12, 95% CI 5.63-14.79, p < .01) and North America (OR 2.18, 95% CI 1.46-3.25, p < .01) agreed more and orthopedic sports medicine physicians agreed less than nonorthopedic sports medicine physicians (OR 0.61, 95% CI 0.39-0.93, p = .02) to this statement. CONCLUSIONS: Sports medicine physicians trained in orthopedics felt sex concordance was less important than physicians trained in other specialties. Asian sports medicine physicians believed sex concordance was more important compared to physicians in other regions.

Sudden Cardiac Death in National Collegiate Athletic Association Athletes: A 20-Year Study.

BACKGROUND: Understanding the incidence, causes, and trends of sudden cardiac death (SCD) among young competitive athletes is critical to inform preventive policies. METHODS: This study included National Collegiate Athletic Association athlete deaths during a 20-year time frame (July 1, 2002, through June 30, 2022). Athlete deaths were identified through 4 separate independent databases and search strategies (National Collegiate Athletic Association resolutions list, Parent Heart Watch database and media reports, National Center for Catastrophic Sports Injury Research database, and insurance claims). Autopsy reports and medical history were reviewed by an expert panel to adjudicate causes of SCD. RESULTS: A total of 143 SCD cases in National Collegiate Athletic Association athletes were identified from 1102 total deaths. The National Collegiate Athletic Association resolutions list identified 117 of 143 (82%), the Parent Heart Watch database or media reports identified 89 of 143 (62%), the National Center for Catastrophic Sports Injury Research database identified 63 of 143 (44%), and insurance claims identified 27 of 143 (19%) SCD cases. The overall incidence of SCD was 1:63 682 athlete-years (95% CI, 1:54 065-1:75 010). Incidence was higher in male athletes than in female athletes (1:43 348 [95% CI, 1:36 228-1:51 867] versus 1:164 504 [95% CI, 1:110 552-1:244 787] athlete-years, respectively) and Black athletes compared with White athletes (1:26 704 [1:20 417-1:34 925] versus 1:74 581 [1:60 247-1:92 326] athlete-years, respectively). The highest incidence of SCD was among Division I male basketball players (1:8188 [White, 1:5848; Black, 1:7696 athlete-years]). The incidence rate for SCD decreased over the study period (5-year incidence rate ratio, 0.71 [95% CI, 0.61-0.82]), whereas the rate of noncardiovascular deaths remained stable (5-year incidence rate ratio, 0.98 [95% CI, 0.94-1.04]). Autopsy-negative sudden unexplained death (19.5%) was the most common postmortem examination finding, followed by idiopathic left ventricular hypertrophy or possible cardiomyopathy (16.9%) and hypertrophic cardiomyopathy (12.7%), in cases with enough information for adjudication (118 of 143). Eight cases of death were attributable to myocarditis over the study period (1 case from January 1, 2020, through June 30, 2022), with none attributed to COVID-19 infection. SCD events were exertional in 50% of cases. Exertional SCD was more common among those with coronary artery anomalies (100%) and arrhythmogenic cardiomyopathy (83%). CONCLUSIONS: The incidence of SCD in college athletes has decreased. Male sex, Black race, and basketball are associated with a higher incidence of SCD.

Alabama Screening and Intervention for Glaucoma and Eye Health through Telemedicine (AL-SIGHT): Baseline Results.

PURPOSE: To describe baseline results of the Alabama Screening and Intervention for Glaucoma and Eye Health through Telemedicine (AL-SIGHT) for patients at federally qualified health centers (FQHCs). Candidates were persons at risk for glaucoma-associated diseases (GAD) based on age, race/ethnicity, current diagnosis of GAD, family history, and diabetes. DESIGN: Baseline screening visit followed by remote diagnosis and referral for follow-up examinations. METHODS: Patients presenting to FQHCs who were at least 18 years of age were enrolled and underwent screening for acuity, autorefraction, intraocular pressure, visual field testing, and fundus imaging. Results were transmitted to an ophthalmologist at University of Alabama at Birmingham for diagnosis who made referrals for follow-up; follow-up attendance was noted. Questionnaires assessed participants' perspectives on screening. Primary outcomes were rates of disease detection, referral for follow-up, follow-up attendance, and participant satisfaction. RESULTS: Of the 500 participants enrolled (mean age 58 years), 45.6% were African American and 51.6% White. Remote diagnostic evaluation of ocular screening by ophthalmologist revealed 30% GAD, 6.8% diabetic retinopathy, 37.6% cataract, 68.4% refractive error, 9.2% other eye conditions. In all, 47.2% of the participants were referred for follow-up examination and for acuity 20/40 or worse or IOP ≥23 mm Hg in one or both eyes. Follow-up examination attendance was 76.7% for those referred. Participants reported being very satisfied with screening (85.8%) and with the convenience of screening in their primary care clinic (92.2%). CONCLUSIONS: The high percentage of patients diagnosed with treatable eye conditions at telemedicine screening suggest these programs in FQHCs can be effective and scalable nationwide. Attendance when referred for follow-up examination was high. Participants welcomed screenings in their communities.

An international study on attitudes and opinions regarding female sports medicine physicians during pregnancy and the postpartum period.

OBJECTIVES: Supporting female sports medicine physicians to simultaneously be mothers and pursue professional careers is crucial to maintain gender diversity in sports medicine physicians. The purpose of this study is to understand the attitudes toward female sports medicine physicians during pregnancy and postpartum. METHODS: An anonymous online survey was distributed to sports medicine physicians practicing in 51 different countries. They were asked how comfortable they felt with female sports medicine physicians working on the sidelines of sporting events during pregnancy, if the female sports medicine physicians were as productive as their male counterparts after giving birth, and how satisfied they were with the percentage of female sports medicine physicians in their country. Data were analyzed using the chi-square test, and multivariate logistic regression analysis was performed to identify independent variables. RESULTS: In total, 1193 physicians (380 [31.9%] female) were included for analysis. Physicians in Asia were the least comfortable with pregnant sports medicine physicians working on the sidelines and those in North America were the most comfortable (odds ratio = 0.28 and 2.51, 95% confidence interval 0.18-0.44 and 1.55-4.06, respectively). More experienced sports medicine physicians (odds ratio = 1.01, 95% confidence interval 1.00-1.03; p < 0.05) and divorced physicians (odds ratio = 0.33, 95% confidence interval 0.12-0.91; p < 0.05) were less comfortable with pregnant female sports medicine physicians working on sidelines, and those trained in orthopedics were less likely to agree that female sports medicine physicians were equally as productive as male counterparts postpartum (odds ratio = 0.29, 95% confidence interval 0.10-0.88; p < 0.05). Female physicians were less satisfied with the percentage of female sports medicine physicians in their country (odds ratio = 0.41, 95% confidence interval 0.27-0.60; p < 0.01) than their male counterparts. CONCLUSIONS: Female sports medicine physicians may experience bias in their practice during pregnancy and postpartum.

Gender bias in sports medicine: an international assessment of sports medicine physicians' perceptions of their interactions with athletes, coaches, athletic trainers and other physicians.

OBJECTIVES: To evaluate the difference between female and male sports medicine physicians regarding disrespectful attitudes and sexual harassment perceived from athletes, coaches, physicians, athletic trainers (ATs) and organisations/administrations. METHODS AND STUDY DESIGN: anonymous survey was distributed to sports medicine physicians practicing in 51 countries. χ2 analysis was used to detect differences between female and male sports medicine physicians and logistic regression analysis was used to determine the independent variables that affect disrespectful attitudes and sexual harassment from sports participants. RESULTS: 1193 sports medicine physicians (31.9% female) participated from 51 countries. The survey revealed that female physicians, compared with male physicians, perceive significantly more disrespect or have their judgement questioned more by the following categories: male and female athletes, male and female coaches, female physicians with more years of experience, male physicians (regardless of years of experience), male and female ATs and organisation/administrations (all p<0.05). The only category where the frequency of disrespect was perceived equally by male and female physicians was during their interactions with female physicians who have the same or lesser years of experience. Female sports medicine physicians noted more sexual harassment than male physicians during interactions with male athletes, coaches, ATs and physicians (all p<0.001). In the logistic regression, gender was a related factor for perceiving disrespect, especially from male coaches (OR=2.01) and physicians with more years of experience (OR=2.18). CONCLUSIONS: Female sports medicine physicians around the world experience disrespectful attitudes, questioning of their judgement and are sexually harassed significantly more often than male counterparts.

Roles of Academic Writers in a Department: Benefits, Structures, and Funding.

BACKGROUND AND OBJECTIVES: Despite the prevalence of published opinions about the use of professional academic writers to help disseminate the results of clinical research, particularly opinions about the use of ghost writers, very little information has been published on the possible roles for professional writers within academic medical departments or the mechanisms by which these departments can hire and compensate such writers. To begin addressing this lack of information, the Association of Departments of Family Medicine hosted an online discussion and a subsequent webinar in which we obtained input from three departments of family medicine in the United States regarding their use of academic writers. This discussion revealed three basic models by which academic writers have benefitted these departments: (1) grant writing support, (2) research and academic support for clinical faculty, and (3) departmental communication support. Drawing on specific examples from these institutions, the purpose of this paper is to describe the key support activities, advantages, disadvantages, and funding opportunities for each model for other departments to consider and adapt.

Analysis of American Medical Students' Knowledge of Physical Activity Recommendations.

INTRODUCTION: The benefits of physical activity (PA) are widely recognized; American medical schools have begun to emphasize PA, but the effectiveness of these changes is unclear. METHODS: We performed a cross-sectional analysis of medical students enrolled in US osteopathic and allopathic medical schools between August 2019 and May 2020. All participants completed an electronic survey about PA instruction across the 4 years of medical school. Objective information including hours and format of PA instruction was collected. Subjectively, participants reported their relative comfort discussing various aspects of PA education with patients. RESULTS: A total of 480 medical students completed the survey, representing 82 of the 192 US medical schools (69 allopathic, 13 osteopathic). Students are more comfortable discussing overall exercise benefits than exercise testing, exercise prescription, and exercise physiology (P<.0001). They also report more exposure to general PA guidelines related to overall PA duration than strength training (P<.0001). Students at allopathic and osteopathic schools reported similar outcomes regarding PA education, while students with class sizes under 200 reported increased familiarity with National Physical Activity Guidelines regarding PA duration (P<.0001) and strength training (P=.01). CONCLUSION: Despite recent efforts to improve PA education in medical school, students feel unprepared to apply their knowledge in a clinical setting and remain unaware of national PA guidelines. Future studies should determine how to practically integrate PA education longitudinally into curricula to change PA education from an afterthought to an essential component of medical school education.

Return to play with hypertrophic cardiomyopathy: are we moving too fast? A critical review.

The diagnosis of a potentially lethal cardiovascular disease in a young athlete presents a complex dilemma regarding athlete safety, patient autonomy, team or institutional risk tolerance and medical decision-making. Consensus cardiology recommendations previously supported the 'blanket' disqualification of athletes with hypertrophic cardiomyopathy (HCM) from competitive sport. More recently, epidemiological studies examining the relative contribution of HCM as a cause of sudden cardiac death (SCD) in young athletes and reports from small cohorts of older athletes with HCM that continue to exercise have fueled debate whether it is safe to play with HCM. Shared decision-making is endorsed within the sports cardiology community in which athletes can make an informed decision about treatment options and potentially elect to continue competitive sports participation. This review critically examines the available evidence relevant to sports eligibility decisions in young athletes diagnosed with HCM. Histopathologically, HCM presents an unstable myocardial substrate that is vulnerable to ventricular tachyarrhythmias during exercise. Studies support that young age and intense competitive sports are risk factors for SCD in patients with HCM. We provide an estimate of annual mortality based on our understanding of disease prevalence and the incidence of HCM-related SCD in different athlete populations. Adolescent and young adult male athletes and athletes participating in a higher risk sport such as basketball, soccer and American football exhibit a greater risk. This review explores the potential harms and benefits of sports disqualification in athletes with HCM and details the challenges and limitations of shared decision-making when all parties may not agree.

Write an exercise Rx to improve patients' cardiorespiratory fitness.

Assessing physical activity is an opportunity to encourage lifestyle-based tactics for reducing cardiovascular risk. These handy tables serve as practical guides.

Cardiovascular Screening of Elite Athletes by Sporting Organizations in Australia: A Survey of Chief Medical Officers.

OBJECTIVE: To compare cardiovascular screening policies of Australian elite sporting organizations. DESIGN: Online survey. SETTING: Elite/professional sports in Australia. PARTICIPANTS: Chief medical officers (CMOs) of elite/professional sports in Australia, including rugby union and league, cricket, tennis, Australian football, and cycling. ASSESSMENT OF VARIABLES: Survey questions about each sport's cardiac screening policy: which screening components were included [eg, history and physical (H&P), resting 12-lead electrocardiogram (ECG)], whether screening was mandatory, whether the policy applied to elite junior and/or adult players, and which criteria were used to interpret ECGs. MAIN OUTCOME MEASURES: Which sports had a formal cardiac screening policy, which athletes the policy applied to, components of screening, ECG interpretation criteria used. RESULTS: Chief medical officers for 22/31 (71%) sports responded, representing >5000 athletes. Of these, 19/22 (86%) perform regular screening (100% H&P; 89% included ECG) with international cyclists also having routine echocardiograms and stress testing. Thirty-three percent of CMOs used the 2017 International Criteria for athlete ECG interpretation. Screening was mandatory with enforcement (26%), mandatory without enforcement (48%), and opt-out (26%). All screened adult elite athletes, and 68% screened junior elite athletes. Forty-two percent indicated athletes were required to pay for screening tests, and 63% required athletes to pay for follow-up tests. Almost all (94%) sports with a sports physician as the CMO screened athletes. CONCLUSIONS: Most sports have a screening policy, with reasonable uniformity of components. All included H&P, and almost all included ECG. Only one sport included an echocardiogram and stress test as a standard (international players only). Promoting the latest ECG interpretation criteria may reduce false-positives and cost. Future work should explore cardiac emergency plans, screening infrastructure, cost, and long-term follow-up.

Clinician Well-being during a Pandemic: Practices to Boost Resilience and Life Satisfaction.

The role of the sports medicine physician has been challenged in several ways during the COVID-19 pandemic, potentially eroding a sense of well-being. Four universal human needs related to flourishing and a sense of life satisfaction are the framework we use to examine the effects of a pandemic on sports medicine clinicians. We offer two evidence-based practices to promote well-being and resilience within each of the four universal needs.