Athletes with heart conditions may not need to give up competitive sports, according to a new scientific statementpublished in Circulation and JACC.
The statement, created by experts from the American Heart Association (AHA) and the American College of Cardiology (ACC), updates previous 2015 guidelines and reflects the latest research on sports participation for athletes with cardiovascular conditions.
A Shift Toward Shared Decision-Making
In the past, athletes with any heart condition were automatically banned from competitive sports. However, the new guidelines emphasize shared decision-making, meaning athletes and their doctors can discuss risks and benefits together before making a decision.
Dr. Jonathan H. Kim, lead author and director of sports cardiology at Emory University, explained:
“Before, there was no room for discussion—any cardiac issue meant automatic disqualification. Now, we recognize that not all heart conditions pose the same level of risk, and participation can be reasonable for some athletes with proper guidance.”
What Has Changed?
- Understanding the “Athlete’s Heart”
Years of research have improved doctors’ understanding of how an athlete’s heart adapts to training. Many heart conditions were once thought to make sports too risky, but new studies suggest the risks may not be as high as previously believed.
- Sports Are No Longer Categorized Strictly by Risk
Previous guidelines divided sports into low-risk and high-risk categories based on their intensity. The new statement takes a more flexible approach, recognizing that:
- Not all athletes train the same way.
- The demands of different sports vary.
- Individual risk levels depend on both the condition and the athlete’s unique health status.
- Expanded Recommendations for Different Athlete Groups
The statement now includes Masters athletes (35+ years old), extreme sports athletes (such as scuba divers and high-altitude climbers), and pregnant athletes.
Key Medical Updates
- Cardiomyopathies (Heart Muscle Disease)
Previously, people with cardiomyopathies (conditions where the heart muscle becomes thick, enlarged, or rigid) were told not to compete in sports. Now, doctors may allow participation in some cases, especially with genetic cardiomyopathies, if proper monitoring and treatment are in place.
- Myocarditis (Heart Inflammation)
Earlier guidelines required a 3–6 month break from sports after a myocarditis diagnosis, but this was based on expert opinion, not data. New research shows that many athletes recover in less than three months, meaning they could safely return to sports sooner with medical supervision.
- Aortopathy (Aorta Abnormalities)
Not all young athletes with an enlarged aorta need to stop playing sports. The new statement provides detailed guidance on evaluating these athletes individually.
- Blood Thinners and High-Impact Sports
Athletes taking blood thinners must carefully consider their sport’s risk level. Contact sports like football, competitive cycling, skiing, or baseball increase the risk of serious bleeding injuries, so doctors should assess these cases individually.
- Genetic Heart Rhythm Disorder (CPVT)
Athletes with catecholaminergic polymorphic ventricular tachycardia (CPVT), a genetic condition that can cause dangerous heart rhythms, were previously automatically disqualified from competition. Now, those who receive proper medical care and risk assessment may be allowed to compete.
The Importance of Cardiac Screening
The new guidelines reinforce pre-participation heart screenings for young athletes, beginning with the American Heart Association’s 14-point evaluation, which includes:
- Physical exams (including blood pressure checks).
- Questions about personal and family health history.
- Electrocardiograms (ECG) for some athletes, as long as expert interpretation is available.
Addressing Social Disparities in Cardiac Risk
One significant knowledge gap that researchers aim to address is the higher rate of sudden cardiac death among young Black athletes. The reasons behind this disparity remain unclear, but experts believe social and economic factors may contribute to poorer health outcomes in these athletes, just as they do in the general population.
Dr. Kim emphasized:
“We know young Black athletes have a higher risk of sudden cardiac death, but we don’t fully understand why. It’s important to study how social disparities affect heart health in competitive athletes.”
What’s Next?
The Outcomes Registry for Cardiac Conditions in Athletes (ORCCA), launched in May 2020, is the first large-scale study tracking long-term health outcomes of athletes with heart conditions. This ongoing research aims to:
- Determine whether continued sports participation helps or harms athletes with heart conditions.
- Gather data on diverse populations, including those affected by social health disparities.
Conclusion
The new scientific statement marks a major shift in sports cardiology. Instead of banning athletes with heart conditions, the guidelines support a more personalized approach, balancing risks and benefits through shared decision-making.
With advances in medical research, better screening, and individualized risk assessment, more athletes with heart conditions may safely stay in the game while protecting their health.
The research findings can be found in Circulation.
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