September 3, 2026Circulation
Clinical Considerations for the Care of the Tactical Athlete With Cardiovascular Abnormalities: A Scientific Statement From the American College of Cardiology and the American Heart Association
Elizabeth H. DineenMark C. HaigneyBenjamin D. LevineMichael J. AckermanAaron L. BaggishTravis BattsAlan C. BravermanEugene H. ChungGeoffrey J. ColeWilliam K. CornwellEddie DavenportPeter N. DeanHarry C. DietzAlexander EastmanM. Alaric FranzosJ. Sawalla GusehTravis E. HarrellEdward A. HultenCynthia A. JamesJonathan H. KimRachel LampertMatthew W. MartinezJoseph W. MayFrancis G. O’ConnorBradley J. PetekAnkit B. ShahDenise L. SmithPaul D. ThompsonMeagan M. WasfyJames A. WattsJulie A. BrothersNisha CharkoudianSharlene M. DayMichael S. EmeryN.A. Mark EstesAntonio B. FernandezMelissa GivensSamuel O. JonesStefanos N. KalesMark S. LinkJames LockeMartin MaronSilvana MolossiAndrew MorganC. MurphyMatthew NeedlemanJames PawelczykDermot M. PhelanKeri M. ShaferWanpen VongpatanasinClyde W. YancyWojciech Zareba
Why the study?
Guidance and education were needed for clinicians and organizations caring for tactical athletes with cardiovascular disease or cardiovascular risk, shaped by occupational demands and fit for full duty assessments.
Key Points
- Comprehensive clinical guidance aligns duty fitness with occupational risk management for any tactical athlete presenting with active or latent cardiovascular disease.
- Across 11 distinct sections, consensus recommendations evaluate conditions including genetic cardiomyopathies and myocarditis to determine safe return-to-duty thresholds.
- Comprehensive literature reviews and multidisciplinary sports cardiology task forces formulated reference tables addressing aortopathy and cardiac channelopathies.
- Highlights occupational fitness determinations to protect team safety, establishing standardized preparticipation cardiac evaluation protocols for operational readiness.
Structured PICO
P
Population
Tactical athletes (firefighters, law enforcement officers, military) with cardiovascular disease or risk for cardiovascular disease
I
Intervention
Clinical considerations and guidance for care and fit-for-duty assessments
This ACC/AHA scientific statement provides comprehensive clinical guidance for managing cardiovascular abnormalities and assessing fit-for-duty status in tactical athletes such as firefighters, law enforcement, and military personnel.
Key expert perspectives
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“A cardiovascular event for a firefighter, police officer or military service member can have implications far beyond the individual, including the success of the mission and lives of others. While clinicians have long had guidance for evaluating competitive athletes with CVD, tactical athletes present a unique set of challenges that have not been adequately addressed.”
“Tactical athletes dedicate their careers to protecting and serving others, often working in physically demanding and life-threatening situations that place unique stresses on the cardiovascular system. Cardiovascular care decisions must balance the health and safety of these individuals with the mission-critical and public safety responsibilities they carry every day.”
“Tactical athletes require a more aggressive approach to CV screening due to the dual obligation to protect both the individual and public safety, as even a brief episode of incapacitation during active duty could place others at risk.”
Implication
Offers structured fit-for-duty guidance for tactical athletes; extends prior competitive sports cardiology frameworks to military, law enforcement, and firefighter populations.
Abstract
AIM The American College of Cardiology/American Heart Association Scientific Statement, “Clinical Considerations for the Care of the Tactical Athlete With Cardiovascular Abnormalities,” was written to provide guidance and education for clinicians caring for the tactical athlete (ie, firefighters, law enforcement officers, military) with cardiovascular disease or risk for cardiovascular disease, and for the organizations overseeing the care and wellness of these athletes. The considerations are shaped by the interaction between occupational demands and fit for full duty assessments, including risk discussions about how a cardiovascular event in a tactical athlete could impact teammates’ well-being, community safety, and overall mission success. METHODS This scientific statement is organized into 11 sections focused on cardiovascular disease processes and other topics that are relevant when considering the potential risks and benefits of performing tasks specific to the tactical athlete. Task forces, comprised of experts in tactical athlete domains, sports cardiology, and the respective topics covered, were assigned to each section, and specific “Clinical Considerations Tables” for clinicians to reference were prepared. Comprehensive literature reviews and an emphasis on tactical athlete–focused data, as available, were integral in the writing of all clinical considerations presented. The framework mirrors that of the recently published, “Clinical Considerations for Competitive Sports Participation for Athletes With Cardiovascular Abnormalities: A Scientific Statement From the American Heart Association and American College of Cardiology.” STRUCTURE The specific sections in this document include: Section 1: Tactical Tasks Classification ; Section 2: The Tactical Athlete Preparticipation Cardiac Evaluation ; Section 3: Ethical and Legal Aspects of Tactical Clinical Management ; Section 4: Genetic Cardiomyopathies ; Section 5: Myocarditis and Other Acquired Cardiac Conditions ; Section 6: Congenital Heart Disease ; Section 7: Aortopathy, Bicuspid Aortic Valve, and Spontaneous Coronary Artery Dissection ; Section 8: Syncope, SCA, Arrhythmias, and Devices ; Section 9: Cardiac Channelopathies ; Section 10: Older Tactical Athlete ; Section 11: Environmental Exposures, PED/S, and Additional Cardiac Conditions and Considerations . Each section provides a summary detailing the rationale for key clinical considerations and the respective Clinical Considerations Table(s).
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Cite This Study
Dineen et al. (2026) conducted a review in Cardiovascular abnormalities in tactical athletes. This AHA/ACC scientific statement provides comprehensive clinical considerations and guidance for the cardiovascular care and occupational evaluation of tactical athletes.