Advocacy has become an increasingly important component of sports cardiology. As public attention surrounding sudden cardiac arrest (SCA) in athletes continues to grow, sports cardiologists are often asked to engage beyond the clinic by helping shape policies related to cardiovascular (CV) screening, emergency preparedness, and access to life-saving interventions. As these conversations move into legislative and public arenas, the sports cardiology community has an important responsibility to ensure that policy remains evidence based, equitable, and focused on interventions most likely to save lives.

Although SCA in athletes is rare, contemporary data demonstrate that it remains unpredictable despite modern screening strategies and continues to represent one of the most visible and emotionally impactful events in CV medicine.¹ Accordingly, the future of sports cardiology will be defined not only by clinical excellence, but also by thoughtful, organized advocacy.

Historically, sports cardiology has centered on preparticipation screening, risk stratification, and return-to-play decision-making. Today, however, sports cardiologists are often asked to engage in broader conversations surrounding emergency preparedness, legislative policy, and implementation of CV safety initiatives at the community and state level (Figure 1). Athlete safety depends not only on identifying CV risk but also on building systems capable of responding effectively when emergencies occur.

Figure 1: From Evidence to Implementation: An Evidence-Based Framework for Sports Cardiology Advocacy.

AED = automated external defibrillator; CPR = cardiopulmonary resuscitation; SCA = sudden cardiac arrest.

Survival after SCA is closely linked to rapid recognition, early cardiopulmonary resuscitation (CPR), and timely defibrillation.² Yet access to automated external defibrillators (AEDs), venue-specific emergency action plans (EAPs), and CPR education remains inconsistent across athletic settings. These gaps represent an important opportunity for evidence-based advocacy to improve outcomes.

Legislative Advocacy: Building Systems That Save Lives

Recent national efforts have demonstrated the power of coordinated advocacy. The Smart Heart Sports Coalition has established a clear, evidence-based framework centered on three pillars¹:

1. AED access within 1-3 min;
2. Venue-specific EAPs; and
3. Mandatory CPR and AED training for coaches and athletic personnel.

Although adoption of these measures has expanded, implementation remains uneven across states.^2,3 Importantly, advocacy does not end with passage of legislation. AED placement without maintenance, or EAPs without rehearsal, may create a false sense of preparedness. Effective legislation must therefore incorporate accountability, education, and long-term sustainability.⁴

A Case Study in Modern Advocacy: Nevada's Smart Heart Law

Nevada's recent experience illustrates how sports cardiologists can meaningfully influence public policy while preserving scientific integrity. Assembly Bill 454 (AB454), developed in alignment with the Smart Heart Sports Coalition framework, established statewide requirements for venue-specific EAPs, timely AED access, and CPR/AED training within school athletics.

During legislative deliberations, a proposal mandating universal electrocardiogram (ECG) screening for all student-athletes was introduced. Although well-intentioned, such a mandate could increase health care disparities, overburden CV resources, and create a false sense of security without clear evidence of improved population-level outcomes. Consistent with contemporary American College of Cardiology (ACC) policy guidance, advocacy efforts successfully supported implementation of evidence-based emergency preparedness measures while opposing the ECG mandate.

The Nevada experience illustrates an important principle of effective advocacy: Advocacy is measured not only by the policies clinicians help enact, but also by the scientifically unsupported proposals they help prevent. Effective advocacy prioritizes interventions with the greatest public health benefit while ensuring legislation remains evidence based, equitable, practical, and sustainable.

Addressing Disparities in Athlete Safety

Equity remains central to sports cardiology advocacy. Resource-rich institutions are more likely to implement comprehensive emergency preparedness programs, whereas underserved schools and communities often face financial, infrastructure, and educational barriers. These disparities translate directly into differences in survival following SCA.⁵

Advocacy should therefore prioritize sustainable funding for AED acquisition and maintenance, scalable CPR education, partnerships with community organizations and professional sports teams, and targeted outreach to underserved populations.

The Power of the Cardiovascular Care Team

Although national organizations provide an important framework, meaningful change frequently begins locally. Clinicians, nurse practitioners, PAs, athletic trainers, and other members of the CV care team are uniquely positioned to influence schools, legislators, athletic organizations, and communities.

Beyond clinical care, CV professionals can assist with development and rehearsal of EAPs, expand CPR and AED education, and engage policymakers to ensure legislation reflects contemporary evidence. Participation in organizations such as the ACC further amplifies these efforts by allowing clinicians to contribute to coordinated advocacy initiatives at both the state and national levels.⁶ Effective advocacy also requires translating complex CV science into clear, actionable messaging for legislators, coaches, parents, and athletes.

Screening, Preparedness, and Evidence-Based Policy

Preparticipation CV screening remains an important component of athlete care and may improve detection of select CV conditions when performed within experienced programs. However, the effectiveness of ECG screening depends on appropriate implementation, clinician expertise in athlete-specific ECG interpretation, and equitable access to downstream CV evaluation. Consistent with recent ACC guidance, legislative mandates for universal ECG screening are not currently supported because of concerns regarding workforce limitations, downstream testing burden, health care disparities, financial costs, and the inability of ECG alone to identify all causes of SCA.^7,8 Advocacy should therefore emphasize comprehensive athlete safety strategies that combine evidence-based screening with robust emergency preparedness, timely AED access, venue-specific EAPs, and widespread CPR education.

A Call to Action

The next phase of sports cardiology will be shaped as much by scientific advances as by how effectively the sports cardiology community engages in athlete safety, emergency preparedness, and CV policy. By partnering with legislators, educators, athletic organizations, and communities, sports cardiologists have a unique opportunity to translate clinical evidence into public policy that improves outcomes for athletes at every level.⁹

Future policy initiatives should continue to be guided by athlete SCA data, emergency response outcomes, implementation science, and disparities research. As sports cardiology continues to evolve, advocacy should be recognized as a core professional responsibility, ensuring that future policies remain evidence based, equitable, sustainable, and focused on the interventions most likely to save lives.

References

1. Smart Heart Sports Coalition. Smart Heart Sports Coalition (Smart Heart Sports Coalition website). Available at: https://www.smartheartsports.com/. Accessed 07/22/2026.
2. Vetter VL, Griffis H, Dalldorf KF, et al. Impact of state laws: CPR education in high schools. J Am Coll Cardiol. 2022;79(21):2140-2143. doi:10.1016/j.jacc.2022.03.359
3. Access to AEDs Act, HR 2370, 118th Cong (2023). Accessed 07/21/2026. https://www.congress.gov/bill/118th-congress/house-bill/2370 
4. American Heart Association. Cardiac Emergency Response Plan and Protocol: Schools (AHA website). 2023. Available at: https://cpr.heart.org/-/media/CPR-Files/Training-Programs/2024-CERP/PDFs-2_13_24/2023-Cardiac-Emergency-Response-Plan-and-Protocol-Schools-Final.pdf. Accessed 07/22/2026.
5. Mason Z, Watson AM, Drezner JA. Emergency preparedness for sudden cardiac arrest in amateur athletic union basketball teams: an opportunity to improve outcomes in higher risk athletes. Clin J Sport Med. 2022;32(6):617-619. doi:10.1097/JSM.0000000000001062
6. American College of Cardiology. Advocacy (ACC website). Available at: https://www.acc.org/tools-and-practice-support/advocacy-at-the-acc. Accessed 07/22/2026
7. Kim JH, Martinez MW, Guseh JS, et al. A contemporary review of sudden cardiac arrest and death in competitive and recreational athletes. Lancet. 2024;404(10468):2209-2222. doi:10.1016/S0140-6736(24)02086-5
8. Kim JH, Baggish AL, Coleman D, et al. Opposing legislative mandates for ECG screening in competitive athletes: a report of the American College of Cardiology Solution Set Oversight Committee. J Am Coll Cardiol. 2026;87(14):1845-1852. doi:10.1016/j.jacc.2025.10.015
9. Dineen EH, Lawrence M, Husaini M, et al. Advocacy in sports cardiology: a call to arms. JACC Adv. 2024;3(6):100985. Published 2024 May 7. doi:10.1016/j.jacadv.2024.100985