Chief medical officers' perceptions of athlete cardiac screening.

Background: Elite athletes are screened for conditions associated with sudden cardiac arrest or death. The complexities of the real-world implementation of cardiac screening are poorly understood. The aim of this study was to understand the barriers and enablers to best practice athlete cardiac screening programs in Australia and New Zealand. Methods: Semi-structed interviews were conducted with chief medical officers (CMOs) of elite sporting organisations in Australia and New Zealand and transcribed verbatim. Interview questions were focused on CMOs' perceptions of cardiac screening within their sporting organisation. Inductive thematic analysis was used to assign themes. Results: Twelve chief medical officers were interviewed between June 2023 and May 2024. Several themes were identified as barriers and enablers to best practice athlete cardiac screening. These themes were: 1. availability of sports cardiology expertise; 2. organisational investment in cardiac screening; 3. timing of screening; 4. accessibility of athletes; 5. athletes aged under 18; and 6. athlete engagement with cardiac screening. For CMOs, key enablers to best practice cardiac screening were access to sports cardiology expertise, together with organisational investment in the form of administrative assistance and sufficient funding to run cardiac screening. A key barrier was the organisational pressure on clinicians to make a clinical decision without sufficient clinical information, especially when screening occurred very close to competition. Conclusions: To implement best practice cardiac screening, there needs to be greater access to sports cardiology expertise, improvement in funding models, and policies guiding the timing of screening before competition.