Top Things to Know: Clinical Considerations for Competitive Sports Participation for Athletes With Cardiovascular Abnormalities
Published: February 20, 2025
Prepared by Jonathan H. Kim MD, MSc, Emory University School of Medicine
- This updated scientific statement, unique to the prior 2015 statement, does not outline criteria for medical disqualifications of athletes. Instead, it emphasizes that risk stratification and considerations of clinical uncertainty should be included when evaluating an athlete with a cardiovascular abnormality or disease.
- Shared decision-making (SDM) is crucial and an ethical obligation in the clinical management of competitive athletes, especially regarding decisions about competitive sports. The updated clinical considerations outlined in this statement reinforce this necessity.
- The statement proposes that competitive sports should be classified on a continuum rather than in discrete categories. When evaluating whether athletes with cardiovascular abnormalities can participate in competitive sports, the SDM process should consider various factors. These include the endurance and strength training loads experienced during competition, individual training routines outside of competition, potential environmental stressors, the risk of bodily collisions (especially for those on oral anticoagulants), and the timing within the training or competitive season.
- A screening 12-lead electrocardiogram (ECG), in addition to a standard 14-point history and physical during the pre-participation cardiac evaluation, is reasonable as long as appropriate and equitable access to expertise in interpreting the ECG and appropriate downstream resources and processes are available.
- A uniform mandate of sports restriction for athletes with all types of genetic cardiomyopathies should not be applied. Appropriate diagnostic and clinical risk stratification evaluations, followed by SDM, should be performed when determining competitive sports participation.
- The previously established timelines of 3 and 6 months for returning to competitive sports after a diagnosis of clinical myocarditis were arbitrary and not based on evidence. An athlete may consider resuming competitive sports training before the 3-month mark, provided they are asymptomatic, have normal cardiac function, show resolution of myocardial inflammation, and demonstrate no abnormalities during exercise testing.
- Clinical considerations for athletes with aortopathy are now succinctly separated into athletes with bicuspid aortic valve with aortopathy and athletes with heritable thoracic aortic disease, gene-positive and gene-negative. Aortic dissection in athletes with bicuspid aortic valve with aortopathy is uncommon, thus competitive sports may be reasonable after complete assessment of aortic size, risk stratification, and SDM.
- For asymptomatic athletes who survive sudden cardiac arrest, resumption of competitive sports is reasonable based on the underlying diagnosis, appropriate therapeutic intervention(s), comprehensive risk stratification, and SDM.
- For the first time, clinical considerations for masters athletes with coronary artery disease, atrial fibrillation, myocardial fibrosis, enlarged aortas, and valve disease are presented. The determination of competitive sports participation should be based on appropriate clinical risk stratification for the respective condition and include SDM.
- This update includes additional conditions and sports not found in previous competitive sports clinical guidance documents. The document also offers considerations for healthy competitive athletes who are pregnant.
Citation
Kim JH, Baggish AL, Levine BD, Ackerman MJ, Day SM, Dineen EH, Guseh II JS, La Gerche A, Lampert R, Martinez MW, Papadakis M, Phelan DM, Shafer KM; on behalf of the American Heart Association Leadership Committee of the Council on Clinical Cardiology; Council on Basic Cardiovascular Sciences; Coun¬cil on Cardiovascular and Stroke Nursing; Council on Cardiovascular Surgery and Anesthesia; Council on Peripheral Vascular Disease; and American College of Cardiology. 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. Published online February 20, 2025. doi: 10.1161/CIR.0000000000001297