Competitive Sports Participation for Athletes with Heart Disease

By Benjamin D. Levine, M.D., FACC, FAHA, FACSM

Professor of Internal Medicine
Director of the Institute for Exercise and Environmental Medicine

The symposium I led at #AHA25 covered the key take-home messages from the recently issued (February 2025) Clinical Considerations for Competitive Sports Participation for Athletes with Cardiovascular Abnormalities, published jointly by the American Heart Association and the American College of Cardiology. This document represents the latest update of a long history of guidelines/recommendations on management of athletes with heart disease, beginning with the 16th “Bethesda Conference” in 1984 and updated every 10 years since then.

Substantial new data over the past decade has informed a rich and comprehensive document that will change clinical practice. Perhaps the most important and compelling change is a paradigm shift away from a relatively paternalistic approach to athletes where the physician decides that an athlete should be “cleared” or “disqualified.” A more modern, “shared decision-making” model emphasizes the physician providing expert evaluation of the athlete and assessment of risk and communicating that to the athlete, family, and other stakeholders as necessary. The athlete (along with other stakeholders) then makes the final decision regarding what risks are acceptable or unacceptable based on their own unique levels of risk tolerance. The new model acknowledges the many complex considerations that must be weighed in determining sports participation for competitive athletes, while allowing for more latitude and the athlete’s voice in these decisions.