Under new guidelines published by the American Heart Association (AHA) and the American College of Cardiology (ACC), athletes with cardiovascular abnormalities may not have to step away from competitive sports. The joint scientific statement, released in Circulation and JACC, suggests that athletes with certain heart conditions can safely compete after a thorough evaluation and shared decision-making process with medical professionals.
The new statement, “Clinical Considerations for Competitive Sports Participation for Athletes with Cardiovascular Abnormalities,” represents a significant shift from previous recommendations. Traditionally, athletes with almost any form of heart disease were automatically disqualified from competition. However, new evidence suggests that the risks may not be as high as previously thought for certain conditions, allowing for more individualized assessments.
“In the past, there was no shared decision-making about sports eligibility for athletes with heart disease,” said Jonathan H. Kim, M.D., M.Sc., FACC, chair of the writing group and director of sports cardiology at Emory University School of Medicine. “This new scientific statement reviews best clinical practices for athletes with certain cardiovascular conditions and how health care professionals can guide these athletes—from children to Masters athletes—in a shared decision-making discussion about potential risks and rewards.”
Updated Understanding of Cardiac Risks and Heart Conditions
The revised guidelines reflect a growing understanding of the “athlete’s heart,” a term that describes the structural and electrical changes that occur in response to habitual exercise. Research over the past decade has shown that, in many cases, the risk of sudden cardiac events is lower than previously assumed. With proper monitoring, some athletes may safely return to play.
Key updates include revised recommendations for individuals with cardiomyopathies, myocarditis, and aortopathy. Previously, those with myocarditis were advised to avoid sports for at least three to six months. New data suggests recovery may be possible in less than three months, allowing for an earlier return under medical supervision. Similarly, athletes with specific genetic cardiomyopathies, once automatically barred from competition, may now be eligible to participate based on clinical evaluation.
The statement also addresses new groups not previously included in past guidelines, such as Masters athletes (aged 35 and older), extreme sports athletes, and pregnant athletes. Additionally, the update provides more guidance on managing the risks for athletes on blood-thinning medications, particularly in high-contact or high-impact sports.
Focus on Pre-Participation Screening and Social Disparities
The statement reinforces the importance of pre-participation cardiac screening, particularly for young athletes. It recommends using the American Heart Association’s 14-point evaluation, which includes a physical examination, family and personal medical history review, and, in some cases, an electrocardiogram (ECG). Experts stress that athletes who undergo screening should have access to appropriate follow-up care if abnormalities are detected.
The guidelines also acknowledge the need for further research on social disparities’ impact on cardiovascular outcomes. Studies indicate that young Black athletes have a higher risk of sudden cardiac death, but the reasons remain unclear. Researchers suggest socioeconomic factors, access to medical care, and potential genetic influences may play a role.
Long-Term Research on Athlete Health
Researchers have launched the Outcomes Registry for Cardiac Conditions in Athletes (ORCCA) to address lingering questions about how sports participation affects athletes with cardiovascular conditions. Established in 2020, this long-term study is the first multicenter, longitudinal research effort aimed at tracking the health of athletes with heart disease over time. Heart Conditions
While the statement acknowledges that some conditions still pose significant risks, it marks a shift toward a more personalized approach to assessing athletic participation. Rather than blanket restrictions, the new guidelines emphasize informed decision-making between athletes and their healthcare providers.
The scientific statement was developed by a volunteer writing group representing multiple councils within the American Heart Association and the American College of Cardiology. Scientific statements summarize current knowledge on a topic and highlight areas for further research but do not constitute official treatment recommendations. Heart Conditions
Reference: Jonathan H. Kim, Aaron L. Baggish, Benjamin D. Levine, Michael J. Ackerman, Sharlene M. Day, Elizabeth H. Dineen, J. Sawalla Guseh, Andre La Gerche, Rachel Lampert, Matthew W. Martinez, Michael Papadakis, Dermot M. Phelan, Keri M. Shafer, Larry A. Allen, Mats Börjesson, Alan C. Braverman, Julie A. Brothers, Silvia Castelletti, Eugene H. Chung, Timothy W. Churchill, Guido Claessen, Flavio D’Ascenzi, Douglas Darden, Peter N. Dean, Neal W. Dickert, Jonathan A. Drezner, Katherine E. Economy
Thijs M.H. Eijsvogels, Michael S. Emery, Susan P. Etheridge, Sabiha Gati, Belinda Gray, Martin Halle, Kimberly G. Harmon, Jeffrey J. Hsu, Richard J. Kovacs, Sheela Krishnan, Mark S. Link, Martin Maron, Silvana Molossi, Jack C. Salerno, Ankit B. Shah, Sanjay Sharma, Tamanna K. Singh, Katie M. Stewart, Paul D. Thompson, Meagan M. Wasfy, Matthias Wilhelm. Clinical Considerations for Competitive Sports Participation for Athletes With Cardiovascular Abnormalities: A Scientific Statement From the American Heart Association and American College of Cardiology. Circulation, 2025.
