Addressing the unmet needs of cardiovascular evaluation in athletes. a national survey of the italian society of cardiology (sic) and the regional associations of ambulatory cardiologists (ARCA)

Introduction: Cardiovascular screening of athletes is of paramount importance in identifying individuals at risk for sudden cardiac death. Performing such evaluations requires specific knowledge and expertise. The educational needs of cardiology community and the perception of sports cardiology as a specific subspecialty needing a dedicated approach have never been explored. Materials and methods: The survey was conducted by the Italian Society of Cardiology (SIC) with the Regional Associations of Ambulatory Cardiologists (ARCA). It was distributed via newsletter and social media to cardiologists, collecting demographic, professional data, and information on clinical practices for evaluating competitive athletes to explore current practices, challenges, and educational needs. Results: A total of 375 responded to this survey revealing that 51.2 % of cardiologists do not have specific training in sports cardiology, despite 90.1 % believing it would improve clinical practice. The majority (58.9 %) operates without a dedicated workflow, and only 25.9 % are part of a specialized team. Legal considerations significantly influence clinical management (60.8 %), and 70.1 % frequently refer athletes to advanced imaging compared to non-athletes. Timely access to imaging services is often limited (76.8 %). There is also an increase in referrals for older athletes (masters), who are often referred by general practitioners rather than sports doctors. Conclusion: The survey highlights significant shortcomings in the practice of sports cardiology in Italy, including a lack of specialist training, dedicated workflows, and multidisciplinary teams. Although cardiologists recognize the importance of sports cardiology, they encounter obstacles in providing optimal care due to limited resources and education. These findings underscore the need for standardized training programs, improved facilities, and a more structured approach to athlete evaluations at European level.