Back in Action: Risk Stratification, Shared Decision-Making, and Emergency Action Plans

Purpose of Review This review provides an updated overview of the evaluation and risk stratification of competitive athletes with cardiovascular conditions and approaches to safe return to competition. Recent Findings Athletes with cardiovascular conditions were historically restricted from competitive sports because of concerns about sudden cardiac death. Contemporary guidelines emphasize assessment based on the underlying condition, sport, and athlete-specific risk factors. The 2025 American College of Cardiology/American Heart Association scientific statement provides a structured framework for risk assessment. Recent condition-specific studies further demonstrate that many athletes can safely continue participation with appropriate monitoring. Summary Sudden cardiac arrest remains the leading cause of mortality among athletes. Genetic, arrhythmic, and structural conditions present distinct risks requiring evaluation. Sport- and position-specific demands, targeted testing, and sports cardiology consultation can guide decisions regarding restriction or participation. Shared decision-making, individualized return-to-play strategies, and emergency action plans promote participation while safeguarding cardiovascular safety.