Feb. 20, 2025 – Athletes with certain heart conditions have long been told by their doctors what they can and can’t do when it comes to competitive sports, and sometimes that even means quitting. But today the American College of Cardiology and the American Heart Association jointly released new guidelines stating that athletes and their doctors should make the decision together, and there is new evidence that risks are lower than previously thought.
The new advice focuses specifically on “competitive athletes” of all ages but will likely be more broadly applied to young people who play high school and collegiate sports, said Paul Kantor, MBBCh, a pediatric cardiologist at Children’s Hospital Los Angeles. Kantor was not involved in crafting the new guidelines.
“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,” Kantor said. “This likely numbers in the tens of thousands of young and aspiring athletes across the nation.”
The recommendation represents a major change, said Jonathan H. Kim, MD, director of sports cardiology at Emory University School of Medicine in Atlanta and a lead author of the guidelines.
“In the past, there was no shared decision-making about sports eligibility for athletes with heart disease,” said Kim, who serves as the team cardiologist for many Georgia professional and collegiate athletic organizations. “These athletes were automatically prohibited from participating in sports if almost any cardiac issue was present.”
Athletes affected by the new guidelines may have inherited heart diseases, electrical problems like irregular heartbeat disorders, heart inflammation (also called myocarditis), a previous heart attack, or even a pacemaker.
The recommendation stems from recent research that examined risks of athletes whose heart condition had been identified and treated, such as those who have implanted cardioverter defibrillators (ICDs).
“What all this data tells us is not that the risk of returning to play is zero, but that it is low,” said Rachel Lampert, MD, a co-author of the guidelines and director of the Yale Medicine sports cardiology program. She has extensively researched sports participation in people with heart rhythm problems.
The new guidelines have a special section for “masters athletes,” which means people ages 35 and older, who commonly have been restricted by diagnoses such as coronary artery disease, atrial fibrillation, and aortic dilation (a bulging in the main heart artery that is sometimes also called aortic aneurysm).
This isn’t, however, a greenlight for competitive athletes with heart disease to play sports without understanding the risks and without medical oversight, said Aaron Baggish, MD, who co-authored the guidelines and is chief of sports cardiology at Lausanne University Hospital in Switzerland.
“This document should encourage people who have been previously restricted to discuss this restriction with their providers,” Baggish said. “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.”
