Abstract 4366963: Practice Variation in Clinician Guidance Regarding Sport Participation in Congenital Heart Disease

Introduction: Athletic participation is increasing among individuals with congenital heart disease (CHD), but there are limited data to guide sports participation decision-making in this population. We conducted a survey to define practice variation in this area focusing on two complex populations post repair (Tetralogy of Fallot (TOF) and D-transposition of the great arteries s/p arterial switch (D-TGA)). Methods: An online survey was distributed by investigators to clinicians treating patients with CHD. Respondents were queried regarding their approach to specific complex congenital patient scenarios and sports participation. Results: A total of 165 cardiologists completed the survey, most (147/165, 89%) in academic practice. Respondents included 95/165 (58%) pediatric cardiologists, 59/165 (36%) adult congenital heart disease (ACHD) specialists, and 11/165 (7%) other subspecialties. TOF: Nearly all respondents (156/165, 95%) reported supporting full sport participation in individuals with well-repaired TOF (without residual lesion or cardiac dysfunction). With severe pulmonic regurgitation, support for full participation remained high (139/165, 84%), but 3/165 (2%) recommended complete restriction and 23/165 (14%) restriction based on sport type (primarily from high static and high dynamic sports, 13/23, 57%). With moderate right ventricular outflow tract obstruction, by contrast, 92/164 (56%) supported full participation and 10/164 (6%) complete restriction, with the remaining 62/164 (38%) recommending sport-specific guidance. D-TGA: A similar majority (154/163, 95%) supported full participation for athletes with repaired D-TGA, but this number was considerably lower when with neo-aortic root dilation (4.0 cm) was added to the patient scenario, with only 50/163 (31%) recommending full participation and a majority (104/163, 64%) recommending sport-specific restriction. Notably, only 52/163 (31.9%) supported participation in contact sports in this specific scenario, although willingness to do so was higher (26/59, 44%) among ACHD specialists compared to pediatric cardiologists (23/95, 25%) (p=0.02). Conclusion: While the vast majority of providers support full sports participation in repaired TOF and D-TGA without residual issues, there is heterogeneity in guidance regarding sports participation in those with post repair issues. This marks an important area for future quality initiatives to ensure alignment with expert guidelines.