A new joint Scientific Statement from the American Heart Association (AHA) and the ACC provides new and updated clinical guidance on how to assess risk when considering competitive sports participation for people with various cardiovascular conditions.

Divided into 11 sections, the statement replaces a previous statement from 2014, and addresses sports classifications; the preparticipation cardiac evaluation; ethical aspects of competitive sports eligibility; cardiomyopathies; myocarditis/pericarditis, valvular heart disease and other acquired cardiovascular conditions; congenital heart disease; aortopathy and spontaneous coronary artery dissection; arrhythmias, devices and ECG abnormalities; cardiac channelopathies; masters athletes; and additional cardiac conditions and considerations (i.e., hypertension, performance-enhancing drugs, pregnancy, etc.).

Of note, the statement authors, led by Chair Jonathan H. Kim, MD, MSC, FACC, and Vice Chairs Aaron L. Baggish, MD, FACC, and Benjamin D. Levine, MD, FACC, highlight new evidence indicating that athletes of all ages who have certain cardiovascular abnormalities or diseases may often safely participate in competitive sports. It also specifically addresses athlete types, like masters athletes, extreme sports athletes and pregnant athletes, not included in previous documents.

Additionally, the statement offers increased guidance for clinicians around risks associated with specific types of sports. For example, certain activities with a higher risk of trauma and bleeding, such as tackle football, competitive cycling, outdoor skiing or baseball, must be considered for athletes taking blood-thinning medications. "We acknowledge that there are times when the risks of competing are much higher than the benefits for athletes with cardiovascular abnormalities," Kim said.

Shared decision-making is also front-and-center in the new Statement. "In the past, there was no shared decision-making about sports eligibility for athletes with heart disease. These athletes were automatically prohibited from participating in sports if almost any cardiac issue was present," said Kim. "This new scientific statement reviews best clinical practices for athletes with certain cardiovascular conditions and how health care professionals can guide these athletes – from children to masters athletes – in a shared decision-making discussion about potential risks and rewards."

Looking ahead, the statement emphasizes the need for more research to better understand how competitive sports participation impacts overall health among athletes with cardiovascular abnormalities, as well as the impacts of social disparities on these athletes. "We have to look at social disparities because it is a very reasonable hypothesis to believe that disparities play an important role in terms of health outcomes for athletes as they do for people in the general population," said Kim.

Read the full statement published in JACC.

Looking for more? Get involved with ACC's Sports and Exercise Cardiology Member Section and register for ACC's Care of the Athletic Heart conference, taking place June 12-14 in Washington, DC, and virtually.