Revista
Portuguesa
de
Cardiologia
42
(2023)
677---678
www.revportcardiol.org
Revista
Portuguesa
de
Cardiologia
Portuguese
Journal
of
Cardiology
LETTER
TO
THE
EDITOR
Current
scenario
of
evidence-based
recommendations
in
sports
cardiology
Atual
cenário
das
recomendac ̧ões
em
cardiologia
desportiva
Sports
cardiology
is
a
growing
area
in
which
there
are
var-
ious
controversial
issues,
including
the
need
for
guidelines
to
standardize
the
assessment
of
individuals
with
cardio-
vascular
disease
(CVD)
and
the
eligibility
criteria
for
sports
participation.
The
2020
European
Society
of
Cardiology
(ESC)
guidelines
on
sports
cardiology
and
exercise
in
patients
with
CVD
1
were
received
with
great
enthusiasm
and
expectation,
since
they
contribute
to
better
risk
stratification
and
exer-
cise
prescription
in
the
presence
of
CVD
and
help
minimize
the
risk
of
adverse
events.
The
aim
of
this
study
was
to
analyze
the
classes
of
rec-
ommendation
and
levels
of
evidence
(LoE)
underlying
the
Figure
1
Distribution
of
classes
of
recommendations
in
the
2020
European
Society
of
Cardiology
(ESC)
guidelines
on
sports
cardi-
ology,
compared
with
other
ESC
clinical
guidelines
(non-ST
elevation
myocardial
infarction
(NSTEMI)
(2020),
cardiovascular
disease
(CVD)
prevention
(2021),
atrial
fibrillation
(AF)
(2020),
valvular
heart
disease
(VHD)
(2021),
and
heart
failure
(HF)
(2021).
2020
ESC
guidelines
on
sports
cardiology
and
to
compare
them
with
other
recent
ESC
guidelines
on
non-ST
eleva-
tion
myocardial
infarction
(NSTEMI)
(2020),
CVD
prevention
(2021),
atrial
fibrillation
(AF)
(2020),
valvular
heart
disease
(VHD)
(2021),
and
heart
failure
(HF)
(2021).
The
ESC
guidelines
on
sports
cardiology
propose
a
total
of
158
recommendations:
52
class
I
(recommended/indicated)
(33%);
43
class
IIa
(should
be
considered)
(27%);
32
class
IIb
(may
be
considered)
(20%);
and
31
class
III
(not
rec-
ommended)
(20%).
Compared
to
the
other
ESC
guidelines,
the
sports
cardiology
guidelines
have
fewer
class
I
and
more
class
IIb
or
III
recommendations
(
Figure
1
).
For
example,
the
mean
frequency
in
the
ESC
guidelines
on
NSTEMI,
CVD
pre-
vention,
AF,
VHD
and
HF
are
50%
for
class
I,
30%
for
class
IIa,
13%
for
class
IIb
and
6%
for
class
III.
The
majority
of
the
recommendations
on
sports
cardiology
(80%)
are
based
on
LoE
C
(consensus
experts’
opinion
and/or
small
studies,
retrospective
studies
or
registries),
13%
on
LoE
B
(single
randomized
clinical
trial
or
large
non-randomized
studies),
and
only
8%
on
LoE
A
(multiple
randomized
clinical
trials
or
https://doi.org/10.1016/j.repc.2022.10.015
0870-2551/©
2023
Published
by
Elsevier
Espa
̃
na,
S.L.U.
on
behalf
of
Sociedade
Portuguesa
de
Cardiologia.
This
is
an
open
access
article
under
the
CC
BY-NC-ND
license
(
http://creativecommons.org/licenses/by-nc-nd/4.0/
).