What is the clinical evidence from this study?

Study design: Case Report. Population: Atrial fibrillation (n=1). Intervention: Shared decision making and lifestyle modification.

December 1, 2021BMJ Case ReportsOpen Access

Shared decision making in athletes with cardiovascular disease: what we can learn from a masters athlete

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Key result

An individualized, shared decision-making approach allowed a 75-year-old masters athlete with atrial fibrillation to manage his symptoms and continue cycling without traditional medical therapy.

Why the study?

Management of athletes with atrial fibrillation is typically based on general population guidelines, but treatment goals for athletes may differ.

Study Design

Type

Case Report (n=1)

Multicenter

Structured PICO

Population

A 75-year-old male masters athlete with exercise-induced atrial fibrillation who engaged in shared decision making to manage his condition.

Intervention

Shared decision making, lifestyle modifications (heart rate monitoring, warm-up routine, use of an electricity-assisted cycle), over-the-counter magnesium supplementation, and discontinuation of anticoagulation (rivaroxaban).

Outcome

Symptom management, quality of life, and ability to continue cycling.patient reported

Shared decision making is essential in managing athletes with atrial fibrillation, as their treatment goals and risk tolerance (e.g., bleeding risk from sports vs. stroke risk) may differ significantly from the general population.

Limitations

Case reports should not be used in isolation to guide treatment choices or public health policy.

Implication

Hypothesis-generating for magnesium and lifestyle in athletic AF; prospective trials needed before clinical adoption.

Abstract

A 75-year-old male cyclist began suffering from palpitations on exertion. Symptoms terminated spontaneously with cessation of physical activity. The episodes caused significant distress with an impact on physical performance and quality of life. An echocardiogram showed a dilated left atrium, and an exercise ECG demonstrated that episodes of atrial fibrillation developed when his ventricular rate was above 140 beats per minute. Rate control could not be offered due to a history of sinus bradycardia nor rhythm control due to low likelihood of success. Anticoagulant therapy was commenced but discontinued at patient request as he considered risks to outweigh benefits given his desire to continue cycling. Management of athletes with atrial fibrillation is based on guidelines for the general population; however, treatment goals for athletes may differ. Shared decision making is essential to allow patients to make informed decisions about their care, accepting that individuals view treatment risks and benefits differently.

Discussion

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Cite This Study

Patel et al. (2021) conducted a case report in Atrial fibrillation (n=1). Shared decision making and lifestyle modification was evaluated. An individualized, shared decision-making approach allowed a 75-year-old masters athlete with atrial fibrillation to manage his symptoms and continue cycling without traditional medical therapy.

synapsesocial.com/papers/6a7b783ef8c4f0860702b232 https://doi.org/10.1136/bcr-2021-245822