Protecting the Hearts of Scholastic Athletes through Advocacy and Community Leadership


Toolkit: This toolkit explains how cardiovascular specialists can take a proactive approach to advance sensible policies and become trusted, expert constituents for state lawmakers. It has successfully guide advocacy efforts in South Carolina, Indiana, Texas, and West Virginia.

While this toolkit is especially valuable for proponents of the heart health of scholastic athletes, the steps outlined are applicable to general cardiovascular advocacy efforts.

It also familiarizes you with the ACC State Government Affairs Team, whose expertise can help make state advocacy an enjoyable, productive, time-efficient activity.

ACC: The American College of Cardiology’s (ACC) has a reputation as a credible expert in advancing sound policies that are focused on patient care. ACC’s strategic plan promotes a Triple Aim: better care, better outcomes and lower costs. ACC’s Advocacy team, chapters, and volunteers strive to meet this Triple Aim by shaping federal and state public policy. The State Government Affairs team within Advocacy focuses on state and payer issues, and empowering and engaging members to advocate for cardiology in the state capitols. Even when opposing legislation or regulations, the ACC is proactive by offering alternative solutions that improve heart health. Policymakers, allies and even adversaries have responded favorably to this approach.

ISSUE FOCUS: Preventing Sudden Cardiac Arrest in Scholastic Athletes: Specific Challenges for the Sports Cardiology Community: When a scholastic athlete dies from sudden cardiac arrest, legislators understandably want to partner with the fallen athlete’s family to prevent further tragedies. Well-intentioned bills are often introduced which unfortunately do not advance the concerns of fallen athletes’ families, altruistic legislators, and other patient advocates. Such provisions often include unclear, problematic liability provisions and mandatory ECG tests that are not operationally feasible due to workforce issues, cost, and logistical concerns. ACC and ACC chapters oppose such proposals but believe simply saying "no" is not in the interest of patients.

Instead, the sports cardiology community is committed to working with state legislators and community leaders to enhance on-site rescue resources and deploy prevention strategies to identify cardiovascular problems before athletes take to the fields and courts. The ACC’s Sports and Exercise Cardiology Council, the American Heart Association (AHA), and state medical societies have authored clinical documents and devised practical recommendations to guide lawmakers and stakeholders in developing public policies aimed at reducing sudden cardiac arrest in scholastic athletes.

Long-Term Approach: Engaging Legislators

Step 1: Building Credibility with Legislators

It is important for legislators to know about the excellent care you provide for the people who put them in office, their constituents before they voice concerns. Legislators love to showcase the institutions and businesses that leverage technology for good. “The pearls of our state” as Maryland Senate President Mike Miller calls them. By telling them of your good work prior to lobbying them you will stand out among the hundreds of interest groups who only seek legislative relief to solve problems.

Example 1: Bryan Heart Athlete Care

In the spring of 2013 prominent cardiologists from across the U.S. convened in Omaha, Nebraska and created the research project “Bryan Heart Athlete Care,” a partnership with Bryan Heart, the University of Nebraska, medical organizations and patient advocacy groups. Engaging local stakeholders committed to improving athletes’ cardiovascular health through research and clinical collaboration was a top priority. After an intense outreach campaign, Nebraska lawmakers formed a task force to improve athlete heart care. The Nebraska Chapter of the American College of Cardiology (NE-ACC), Nebraska chapters American Heart Association, (AHA), the American Academy of Family Physicians (AAFP), the American Academy of Pediatrics (AAP), the Nebraska School Activities Association (NSAA) and health care experts such as school nurses and athletic trainers and a dozen like-minded organizations enthusiastically joined the cause.

Bryan Heart Athlete Care features a leading-edge research center that studies student-athletes’ hearts to discover warning signs. Cardiovascular problems in athletes are unusual but not rare, and they’re catastrophic when they occur. However, reliable data for predicting cardiac problems in athletes isn’t yet available.

The Bryan Heart Athlete Care seeks to collect valuable data. Its efforts include a study that uses athletes from various sports, since each sport affects the heart differently. The Bryan research team is conducting four major surveys of schools and providers to gauge existing resources to better identify the resources needed to improve outcomes.

Example 2: ACC Sports & Exercise Co-Chair Applies NFL Leadership to Protecting High School Athletes

At the National Football League's (NFL) Scouting Combine in Indianapolis, draftees perform strength and agility drills for NFL scouts. But before taking the field, each must undergo cardiac screening. Richard Kovacs, MD, FACC, a former ACC Sports and Exercise Council co-chair, heads this four day effort.

“This is about screening, but it’s also about science,” Kovacs said. “This is the third year that we’ve done a very specific screening with echocardiograms and electrocardiograms, the same for each player, and at the end of these three years we’re going to evaluate this critically and scientifically.”

Kovacs’ efforts extend to high school athletes. For years he has worked with state lawmakers to improve heart health and prevent sudden cardiac arrest (SCA). In January 2013 he helped usher through legislation that requires CPR training for high school graduation and establishes SCA education for coaches and trainers. “These tragic deaths can take the wind out of a community,” Kovacs said. "I’m trying to apply science so we can detect these things and respond in the right way. No screening program will be perfect, or prevent all on field mishaps – but having contact and credibility with legislators is critical, so lawmakers and citizens understand the limits of our ability to legislate safety.” Thanks to Dr. Kovacs reputation as a compassionate caregiver and leading clinician legislators routinely seek his opinion.

Step 2: Legislator Practice Visit Planning

Hosting a legislator practice visit at your facility is an excellent way to familiarize them with your work. “The best way to show us is to show us – bring us to your business. We need to learn from you”, former Springfield councilmember Jon Holtzee would say. The ACC State Government Affairs Team can cover costs associated with the meeting and will handle arrangements, including scheduling, correspondence, food and refreshments, and background materials. Schedule permitting, a member of the State Government Affairs Team is usually available to attend the meetings to make sure everything goes as planned.

The following are some sample legislator practice visit materials which can be customized for your needs:

Sample Pre-Meeting Checklist for ACC Staff

Office Tour for State Delegate Pete Politics hosted by John Heartbeat, MD, FACC, of Smithville Cardiology

  1. Identify mutually acceptable dates for Del. Politics and Dr. Heartbeat
  2. Draft formal invitation letter explaining what the tour will include (i.e. viewing a coronary revascularization, medical imaging technology, cardiac rehab session) with a brief schedule of events.
  3. Create handouts for advocacy issues
  4. Contact caterer for food delivery order
  5. Send reminder information to legislator (i.e. date, time, parking, etc.)

Sample Agenda

Introductions, informal discussion of tour, how you can serve as a resource for state legislators

9:45-10 a.m. BREAK

10:00-11:30 a.m. TOUR
Suggestions for viewing and explanations: imaging or other CV technology, coronary revascularization; cardiac rehab

11:30-11:40 a.m. BREAK

Members of your cardiac care team briefly explain their roles. Suggested topics for group discussion: operations, business costs, efforts to improve outcomes, support of scholastic athletes’ heart health in the community

12:40-12:45 p.m. FINAL REMARKS

Step 3: Promoting Sensible Legislation


Legislators and legislative staff welcome input from experts. Another proven way to share your expertise and communicate your legislative requests is holding a lobby day. The ACC and its chapters have a proud tradition of hosting lobby days and often partner with other groups such as American Heart Association affiliates and state medical societies. Chapter members convene in the state capitol to meet with their elected officials to discuss how proposed legislation will affect your patients and your profession.

We recommend promoting that relevant legislation include the following components, in order to create a safer environment for student athletes:

  • Training
    • Cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) training for high school staff and students– must include motor skills component.
  • Rescue
    • Sound liability laws – they must not put coaches and volunteers in a position to make medical judgments.
  • Prevention
    • The pre-participation physicals used for student athletes should be uniform and encourage providers to alert school administrators, coaches and volunteer cardiovascular specialists about potential cardiac issues.
    • As part of the information gathering process officials should make every to collect medical history, including family history of sudden cardiac arrest (SCA). Our team can help you find and review the document used in your state.

Our team can also help connect you to experienced allies in your state, such as the state medical society or American Heart Association (AHA) affiliates.

Case Study: A lobby day successfully promotes an alternative approach to more testing.

An example of this kind of advocacy in action occurred in Indiana in 2014 during an AHA/Indiana-ACC lobby day.

The following paper was distributed during this lobby day; additionally Richard Kovacs, MD, FACC, former ACC Sports and Exercise Council chair and Robert Frye, MD, MACC, governor of the ACC chapter of Indiana, testified on the legislation and met personally with lawmakers and AHA staff and patient volunteers to address legislator concerns. A bill of concern, IN H 1290, was successfully amended to address chapter concerns regarding coach liability and has since been signed into law. Our team can help you draft a relevant position paper similar to the following:

February 11, 2014 –Indiana-ACC/American Heart Association Lobby Day

The Indiana Chapter of the American College of Cardiology (IN-ACC) is fully committed to preventing sudden cardiac arrest in scholastic athletes. We believe focusing on training, education, research and prevention approach as opposed to mass testing is the best strategy to prevent sudden cardiac arrest. What follows are recommendations for addressing sudden cardiac arrest and athlete heart health in state legislation. These recommendations are derived from research and clinical practice standards compiled by the ACC and its Sports & Exercise Council, the American Heart Association and various state medical societies.

  1. The pre-participation history and physical (PPE) is the current standard of care and should be continued. It is a valuable tool as a means to keep athletes accountable for health screening and establishing a baseline for many potential injuries. The 4th Edition PPE Monograph history and physical form (1) that is inclusive of the 12-Element American Heart Association Recommendations for the Pre-participation Cardiovascular Screening of Competitive Athletes (2) should be included on PPE forms.
  2. Parent/guardian involvement in the care of athletes is critical. Ideally, the pre-participation evaluation and related decisions should always be undertaken by the athlete in conjunction with the parent(s) and/or guardians and the team physician. Indeed, the exclusion of parents from the care of student athletes is detrimental to the student’s health and well-being.
  3. We strongly support the presence of Certified Athletic Trainers (ATCs) at all sports venues where student athletes pursue their particular discipline. Data exist to support the benefit of athletic trainers in school settings (3).
  4. The availability and application of Automated External Defibrillators (AEDs) to Indiana student athletes should be immediate and well-rehearsed in practice and game settings. Established protocols should exist in all school settings and AEDs should be available and functional with trained personnel ready to respond immediately.
  5. Athletes with family histories consistent with SCD risk factors or symptoms of exertional chest discomfort, dizziness, syncope or near syncope, palpitations, unexplained fatigue or exhaustion inconsistent with their exercise or fitness should be strongly considered for advanced cardiac evaluation. This evaluation may include advanced cardiac testing and should be driven by physicians familiar with cardiac adaptations to exercise and SCD in athletes.
  6. We strongly encourage pre-participation and on-site training for coaches and staff, however even under ideal circumstances they cannot be expected to identify a symptom each time it occurs. Moreover, holding them liable for failing to identify symptoms is not only unrealistic, but a disincentive for others to volunteer. The same is true for physicians, nurses and other providers because they are working in an environment where they are not in a position to see symptoms manifest.

Conclusion: Working with ACC Advocacy

State Government Affairs

The State Government Affairs Team works with a broad range of additional issues, and is your link to state legislatures and state health departments. Our mission is to ensure Cardiology’s advocacy concerns are heard loud and clear in halls of state governments. This means preparing and positioning you, the expert constituent, to advocate in person before lawmakers and mobilizing the collective voice of the cardiology community through grassroots campaigns.

Relevant issues debated in state capitols and state health agencies are identified by the State Government Relations Team, who then review them with ACC chapters and, when appropriate, engage members and allies to advance Cardiology’s position. The Board of Governors and the Board of Trustees approve national campaigns on state issues. On occasion the ACC president will support these advocacy efforts in writing, to show legislators that the ACC is solidly supporting its chapters.

We are available to meet or speak with you to discuss how to best position you to advocate successfully deliver Cardiology’s message in the state capitols. Please contact us to learn more or get started: