Top Things to Know: Clinical Considerations for the Care of the Tactical Athlete With Cardiovascular Abnormalities
Updated: September 03, 2026
Prepared by Mu Huang, PhD, DPT, Science and Medicine Advisor
- This scientific statement is the first ACC/AHA document intended to provide formal cardiovascular care guidance specifically for tactical athletes, including military personnel, firefighters, and law enforcement officers.
- Tactical athletes encounter unique occupational demands, such as intermittent high-intensity exertion, exposure to extreme environments, use of heavy equipment, and engagement in life-threatening situations, all of which contribute to cardiovascular risk.
- Cardiovascular disease constitutes the primary medical cause of duty-related mortality among tactical athletes, with fatality rates exceeding those observed in the general population.
- Tactical tasks often involve cardiovascular strain amplifiers, such as heat, stress, and dehydration, that significantly increase cardiac workload.
- Distinct from shared decision-making in sports, this statement proposes Tactical Clinical Management (TCM) as a novel framework for integrating medical care, operational risk, and mission impact.
- Preparticipation screening is critical for all tactical athletes and includes a history and physical examination. An ECG should be performed in tactical athletes <40 years of age exposed to significant cardiovascular strain or in mission-critical roles, and is reasonable for other tactical athletes.
- As screening alone cannot prevent all sudden cardiac arrests, organizations benefit from maintaining Emergency Action Plans and ensuring rapid access to AEDs.
- Fitness-for-duty determinations should not only account for individual health risks but also for potential risks to team members, mission success, and public safety.
- Task-specific risk stratification is necessary and should include considerations such as collision risk, anticoagulation status, environmental exposures, emergency preparedness (including AED availability) and availability of emergency medical care.
- This document is intended to provide a dynamic framework; however, substantial gaps in evidence-based care persist. The statement advocates for future research initiatives, including the development of registries, improved screening strategies, and risk models tailored to these athletes.
Citation
Dineen EH, Haigney MC, Levine BD, Ackerman MJ, Baggish AL, Batts TC, Braverman AC, Chung EH, Cole GJ, Cornwell WK III, Davenport E, Dean PN, Dietz HC, Eastman A, Franzos MA, Guseh JS, Harrell TE, Hulten EA, James CA, Kim JH, Lampert RJ, Martinez MW, May JW, O'Connor FG, Petek BJ, Shah AB, Smith DL, Thompson PD, Wasfy MM, Watts; on behalf of the American Heart Association Leadership Committee of the Council on Clinical Cardiology, Council on Basic Cardiovascular Sciences, Council on Cardiovascular and Stroke Nursing, Council on Cardiovascular Surgery and Anesthesia, Council on Peripheral Vascular Disease, and the American College of Cardiology. Clinical Considerations for the Care of
the Tactical Athlete With Cardiovascular Abnormalities: A Scientific Statement From the American College of Cardiology and the American Heart Association. Circulation. Published online September 3, 2026. doi: 10.1161/CIR.0000000000001476