Increasing numbers of medical professionals across numerous subspecialty fields have embraced various social media platforms, leveraging the ability to educate the general public and colleagues on important updates in science and public health initiatives. Most recently, this has been exemplified by infectious disease experts throughout the coronavirus disease 2019 (COVID-19) pandemic. The rise of the so-called SoMe (social media) era has also been positive in cardiology, with experts disseminating important summaries of various cutting-edge clinical trials, reviewing core cardiology educational content, and discussing pressing issues we currently face in our field such as advancements in diversity, equity, and inclusion. The extended outreach and value of "tweetorials" from esteemed colleagues around the world have facilitated a convenient outlet, both immediate and easily digestible, for education on best clinical practices and information on potential new therapies. Responsible use of these social media platforms has revolutionized our ability to disseminate important information in a specialty that continues to increase in complexity but with providers short on time.
On the other hand, although negative consequences arising from irresponsible practices on social media are not unique to sports cardiology, there are unique aspects within this subspecialty that amplify the perilous consequences of social media misuse. In particular, although cases of sudden cardiac arrest (SCA) and death are rare in young competitive athletes, when they occur, events are highly visible in the public eye and emotionally traumatic for all involved, including those who witness these tragic episodes. In addition, events are sometimes viewed on television. Combined with subsequent media attention, these cases provide substantial stimuli for social media discourse on "why?" Before the advent of the internet, Hank Gathers of Loyola Marymount University collapsed and died during a nationally televised collegiate tournament basketball game on March 4, 1990. He was a likely National Basketball Association lottery draft pick. Imagine the Twitter dialog if this occurred present day based on the responses after the SCA of University of Florida basketball star Keyontae Johnson during another nationally televised game on December 12, 2020.[1] Other recent examples of premature and reckless SCA judgments (ie, rendered "guilty" verdicts as to cause and manner of the SCA) include Christian Eriksen (Union of European Football Associations European Football Championship 2020) in 2021[2] and now Damar Hamlin of the Buffalo Bills (National Football League) on January 2, 2023.[3] Rampant speculation of links to prior COVID-19 infection or the COVID-19 vaccine in the cases of Johnson and Eriksen, respectively, was expeditiously debunked.
Egregious disinformation campaigns throughout the COVID-19 pandemic have been a significant problem magnified throughout social media's various echo chambers. In sports cardiology, appropriate sensitivity for concerns of COVID-19 and vaccine-associated myocarditis has been taken advantage of by those with an agenda focused on disinformation. More recently, this has manifested in extreme COVID-19 vaccine disinformation campaigns with media reports of health issues in athletes and even nonathletes distorted in both a non-evidence- and non-reality- based fashion that defies basic scientific reason. This dangerous manipulation and disrespect of those targeted in these reports threaten the health and safety of all patients, including young athletes. It is within this domain that we can and should collectively push back, leveraging social media to correct the false narratives threatened by those favoring disinformation over truth.
Situations in which colleagues may, at times, unintentionally contribute to poor messaging occur when there is a rush to clinical judgment and diagnosis. Heightened social media attention on high-profile cases of athlete SCA may lead to questionable tweets, as demonstrated by the recent examples previously listed. After the collapse of Keyontae Johnson, numerous tweets from medical professionals and media reports[4] questioned the significance and role of a disclosed COVID-19 infection several months before his SCA event. This resulted in the family having to publicly disclose that there was no association with prior COVID-19 in this outcome and to publicly release results of an independent medical review of the case, which led to the same conclusion (We were not a part of this independent medical review).[5] Fast forward to this year. Within minutes after the nationally televised SCA of Damar Hamlin, rampant speculation erupted over social media, also from medical professionals, that included a near-instantaneous "guilty verdict" of commotio cordis as the obvious explanation. This premature conclusion was based solely on what was seen on television and preceded any medical evaluation or knowledge of critical details in Hamlin's medical history. Easily accessible video tutorials on commotio were posted online from medical experts and before any public release of medical information; other medical societies and journals dedicated content reviewing aspects of the diagnosis. Disappointingly, commotio cordis is an entity that represents a diagnosis of exclusion after completion of a comprehensive post-SCA evaluation/investigation. Such an evaluation can take at least 2 to 3 weeks to complete if genetic testing is indicated.
Reckless speculation over social media of a presumptive medical diagnosis or factor(s) associated with a SCA outcome is problematic for several reasons. First, when uninvolved in the care of a SCA case, the privacy of those affected should be respected as much as possible. In these circumstances, although First Amendment rights protect the expression of opinions in public forums, medical professionals should always appreciate the extreme emotional stresses felt by those affected and consider the potential profound implications of their typed words over social media. Second, significant unintended negative corollaries may result from uninformed opinions disseminated by medical experts. Social media influence could potentially bias the medical evaluation and lead to inadequate, hasty, or incomplete assessments. Last, in clinical investigations that conclude without a clear determination of cause, a previously amplified premature diagnosis, whether accurate or not, may remain the definitive verdict in the court of public opinion and perhaps in many medical circles. The ramifications of this type of potential outcome biasing future research defining the accurate epidemiology of athlete-associated SCA are concerning and should not be underestimated.
We feel that there is a need to address these social media pitfalls in the sports cardiology sphere. We should not be contributing to poor messaging propagated over the internet. Although perhaps not as appalling as blatant disinformation attempts, suggesting an uninformed "clear" diagnosis or key factors associated with an SCA event has the potential to lead to significant negative consequences. Rather, we should promote responsible narratives after high-profile events, educate the public without influencing premature conclusions, and push back on irresponsible parties with agendas who promote clear disinformation campaigns.
Leveraging social media provides the medical community tremendous educational outreach, and we should continue to promote the use of these platforms. However, with this powerful tool at our disposal comes recognition of the tremendous mandate to avoid careless actions and to ensure responsible use of Twitter. As we have observed through the lens of sports cardiology and recent highly magnified SCA cases, caution must be exercised before engaging in specific commentaries on individual cases. It is on us, collectively and in particular those who regularly care for athletes, to promote responsible social media discourse. We must strive to ensure that privacy is respected for athletes and their families affected by SCA and to exercise restraint in sharing presumptive thoughts in the immediate aftermath of a close-call (SCA) or completed tragedy (sudden cardiac death).
Acknowledgments
The authors acknowledge Dr Benjamin D. Levine, who provided critical guidance of the content included and discussed in this article.
Sources of Funding
None.
Circulation. 2023;147(19):1419-1421. © 2023 American Heart Association, Inc.
