For years, athletes diagnosed with heart conditions have faced tough decisions regarding their participation in competitive sports. Traditionally, doctors often determined that individuals with heart issues should refrain from high-intensity physical activity to prevent life-threatening complications. However, a groundbreaking shift has taken place. The American College of Cardiology (ACC) and the American Heart Association (AHA) have introduced new guidelines that advocate for shared decision-making between doctors and athletes, allowing many individuals with heart conditions to safely return to sports.
The updated guidelines reflect a growing body of research indicating that the risks associated with athletic participation for individuals with managed heart conditions are lower than previously believed. These recommendations specifically focus on “competitive athletes” of all ages, but they are expected to influence how young people, particularly high school and collegiate athletes, engage in sports.
Dr. Paul Kantor, a pediatric cardiologist at Children’s Hospital Los Angeles, emphasized the impact of these changes:
“There are many children and youth who have undergone treatment for a heart condition, or who have a genetic risk for heart problems, that will [now] be encouraged to participate safely in competitive-level sports. This likely numbers in the tens of thousands of young and aspiring athletes across the nation.”
This shift means that more young athletes, previously sidelined due to heart-related concerns, may have the opportunity to train and compete under careful medical supervision.
Under the previous approach, athletes with any form of heart disease were often advised to avoid competitive sports altogether. The new guidelines, however, recognize that different conditions carry varying levels of risk. Athletes affected by these updates may include those with:
Inherited heart diseases, such as hypertrophic cardiomyopathy
Electrical disorders that cause irregular heart rhythms (arrhythmias)
Myocarditis (heart inflammation)
A history of heart attack
Pacemakers or implantable cardioverter defibrillators (ICDs)
Dr. Jonathan H. Kim, director of sports cardiology at Emory University School of Medicine and a lead author of the guidelines, explained:
“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.”
Now, physicians and athletes will work together to assess the potential risks and benefits of continued participation in competitive sports
Recent studies have played a crucial role in shaping these guidelines. Research has shown that athletes who have received proper treatment and medical oversight for heart conditions can often participate safely in sports. For example, individuals with ICDs devices that regulate heart rhythms have been found to have a lower-than-expected risk of cardiac arrest during exercise.
Dr. Rachel Lampert, director of the Yale Medicine sports cardiology program and a co-author of the guidelines, noted:
“What all this data tells us is not that the risk of returning to play is zero, but that it is low.”
This growing evidence supports a more individualized approach, considering an athlete’s specific diagnosis, treatment history, and overall heart health.
The new recommendations also include guidance for “masters athletes” individuals aged 35 and older who have historically been restricted due to conditions like coronary artery disease, atrial fibrillation, and aortic dilation. These conditions are more common with aging, and the previous approach often led to broad restrictions on participation in sports. However, the new guidelines acknowledge that with proper monitoring and treatment, many older athletes can continue to engage in competitive sports safely.
Despite the shift in perspective, experts caution that this is not a blanket approval for all athletes with heart disease to return to competition without medical oversight. Each case must be carefully evaluated, and participation should be determined through collaborative discussions between athletes and their healthcare providers.
Dr. Aaron Baggish, chief of sports cardiology at Lausanne University Hospital in Switzerland and a co-author of the guidelines, stated:
“This document should encourage people who have been previously restricted to discuss this restriction with their providers. In many, if not most cases, restrictions are made with the best of intentions, and this document clearly emphasizes the role of the doctor, which is to provide medical facts, disclose areas of scientific uncertainty, and provide clinical opinions about the risks and benefits of sport.”
Ultimately, the revised guidelines represent a step toward a more inclusive and individualized approach to heart health in athletics. They provide hope for many athletes who have been forced to abandon their passions, offering them the opportunity to safely re-enter the competitive sports world under medical guidance.
