The American College of Cardiology (ACC) and the American Heart Association (AHA) just released guidance regarding athletes with cardiovascular abnormalities. The scientific statement, Clinical Considerations for the Care of the Tactical Athlete with Cardiovascular Abnormalities, features 11 sections focusing on cardiovascular disease topics relevant to the risks and benefits of performing as a tactical athlete.

The ACC/AHA guidance is intended to be a tool for clinicians involved in the cardiovascular care of tactical athletes. It provides risk assessments based on expert opinion, the best available data, or both. The ACC/AHA believes this scientific statement to be the first of its kind, specifically focused on tactical athletes with cardiovascular abnormalities.

Today, we’re featuring key highlights from the ACC/AHA scientific statement on the care of the tactical athlete with cardiovascular abnormalities. The key highlights, summarized and provided in the statement, are grouped by section. View the full-text version of the guidance for the complete look at the ACC/AHA guidance statement, including associated rationale and future directions.

Highlights from the ACC/AHA 2026 Statement on the Care of the Tactical Athlete with Cardiovascular Abnormalities

Tactical Tasks Classification

  • Provides classification schema for tactical tasks based on cardiovascular demands
  • Cardiovascular strain amplifiers’ introduction, exposures that may be encountered that augment anticipated cardiovascular strength and endurance physiologic demands for any given tactical task
  • Tactical athlete task-specific considerations related to anticoagulation and risk of bodily collision, impact, or projectile impact are included
  • Tactical task-specific functional, physiologic testing, or both can be considered as part of the risk stratification process

Tactical Athlete Preparticipation Cardiac Evaluation

  • A standardized cardiovascular history and physical examination should be performed for all tactical athletes before training
  • An ECG should be performed as part of the preparticipation (preaccession) screening of tactical athletes <40 y of age who could be exposed to greater than mild cardiovascular strain amplifiers or whose incapacitation would compromise lives, missions, or both. An ECG is reasonable to consider for all other tactical athletes
  • Functional standards should be established by the tactical organization and used specific to the tactical tasks both for accession and retention evaluations
  • EAP should be developed and practiced at regular intervals. AED access should be part of EAP

Ethical and Legal Aspects of Tactical Clinical Management

  • Introduction of TCM, a new framework for guiding fit for full duty evaluation for tactical athletes. This stepwise approach incorporates best clinical practice and tactical risk assessment, tactical athlete preferences, anticipated tactical tasks, and organizational mission
  • The U.S. Military is exempt from the Genetic Information Nondiscrimination Act. If genetic testing is performed, genotype alone should not guide TCM, except for conditions that have high penetrance or are exacerbated by higher endurance activity

Genetic Cardiomyopathies

  • Genetic cardiomyopathies are progressive with age-related penetrance, typically with autosomal dominant inheritance. Ongoing surveillance, individualized clinical management, and reassessment of the risks associated with tactical tasks are required not only for those with genetic cardiomyopathies but also for at-risk athletes, because phenotypic conversion often occurs during early adulthood
  • Clinical considerations are provided for tactical athletes with HCM, ACM, DCM

Myocarditis and Other Acquired Cardiac Conditions

  • Clinical considerations are provided for tactical athletes with myocarditis and valvular heart disease
  • Clinical considerations are provided for task-specific physiologic testing for further risk stratification of valve disorders

CHD

  • Clinical considerations are provided for tactical athletes with CHD within the context of estimated cardiovascular risk (mild, moderate, or severe)

Aortopathy, Bicuspid Aortic Valve, and Spontaneous Coronary Artery Dissection

  • Clinical considerations are provided for tactical athletes with aortopathy, including postaortic dissection and surgical repair

Syncope, SCA, Arrhythmias, and Devices

  • Clinical considerations are provided for syncope, SCA, and arrhythmias
  • CIED selection should weigh the risks of potential trauma with tactical tasks and pacing needs
  • Remote transmission from cardiac devices may not be possible among some tactical athletes who are deployed or in extreme environmental conditions
  • Postmortem genetic testing is recommended to increase the diagnostic yield of an autopsy examination

Cardiac Channelopathies

  • TCM should include consideration of medication requirements in tactical missions that may increase arrhythmic risk (ie, antimalarials may prolong QT interval)
  • Clinical considerations are provided for tactical athletes with LQTS, CPVT, and Brugada syndrome

Older Tactical Athlete

  • Clinical considerations are provided for the older tactical athlete (≥40 y of age), including coronary atherosclerosis, AF, and aortic enlargement

Environmental Exposures, PED/S, and Additional Cardiac Conditions and Considerations

  • Clinical considerations are provided for hypertension, VTE, and SCT
  • Clinical considerations are provided for environmental exposures (ie, heat, cold, altitude, diving, microgravity), including cardiovascular physiologic responses, cardiovascular conditions exacerbated, and preventive measures

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