Task Force 2: Clinical Considerations for the Pre-Participation Cardiac Evaluation of Competitive Athletes

Q: What is the clinical evidence from this study?

Population: Sudden cardiac arrest / cardiovascular conditions in competitive athletes. Intervention: Pre-participation cardiac screening (focused history & physical and 12-lead ECG). Primary outcome: Identification of previously unrecognized cardiovascular conditions that may increase the risk of sudden cardiac arrest/death during sports participation.

Q: What does this research mean for the field?

Pre-participation cardiac screening combining a focused history, physical examination, and 12-lead ECG alongside an emergency action plan is recommended to identify cardiovascular risks and mitigate sudden cardiac arrest in competitive athletes. Novelty: ClaimNovelty.SYNTHESIS. Consensus alignment: ConsensusAlignment.NEUTRAL.

Sheela Krishnan; Jonathan A. Drezner; SANJAY SHARMA; Guido Claessen; Dermot M.J. Phelan; Antonio Pelliccia; Jonathan H. Kim; Aaron Leigh Baggish; BENJAMIN D. LEVINE; Michael Papadakis

doi:10.1249/mss.0000000000004090

November 13, 2026Medicine & Science in Sports & Exercise

Task Force 2: Clinical Considerations for the Pre-Participation Cardiac Evaluation of Competitive Athletes

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Why the study?

Sudden cardiac arrest is the leading cause of sudden death during sports and exercise, and pre-participation cardiac screening warrants careful planning to maximize efficacy and minimize potential harms, including exacerbating health disparities.

Key Points

To outline clinical strategies for pre-participation cardiac screening in competitive athletes to identify undetected cardiovascular conditions and mitigate the risk of sudden cardiac arrest.
Expert consensus recommendations developed by the task force regarding comprehensive pre-participation cardiovascular evaluations (PPE).
Core screening elements require a focused history and physical examination alongside a 12-lead electrocardiogram administered by trained clinicians.
Effective implementation relies on ready access to expert consultation for secondary evaluations while carefully planning to avoid worsening health disparities.
Because primary pre-participation screening cannot offer absolute protection against sudden cardiac arrest, establishing a well-developed emergency action plan is vital across all athletic levels.

Structured PICO

P

Population

Competitive athletes undergoing pre-participation cardiac evaluation

I

Intervention

Pre-participation cardiac evaluation including a focused history & physical (H&P) and 12-lead electrocardiogram (ECG) conducted by well-trained clinicians, with expert consultation for secondary evaluation and a well-developed emergency action plan

O

Outcome

Identification of previously unrecognized cardiovascular conditions that may increase the risk of sudden cardiac arrest or death (SCA/D) during sports participation

Provides clinical task force considerations for pre-participation cardiac screening in competitive athletes, emphasizing a focused H&P, 12-lead ECG, expert consultation, and emergency action plans while minimizing health disparities.

Limitations

No primary prevention screening approach provides absolute protection against sudden cardiac arrest
Potential harms of screening include exacerbating health disparities
Potential to exacerbate health disparities if not carefully planned

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Implication

Supports adoption of ECG-inclusive screening plus emergency plans in athletes; extends consensus on SCA prevention strategies.

Abstract

Sudden cardiac arrest (SCA) is the leading cause of sudden death during sports and exercise. Pre-participation cardiac screening is one component of the comprehensive pre-participation evaluation (PPE), aiming to identify previously unrecognized cardiovascular conditions that may increase the risk of SCA/D during sports participation. It warrants careful planning to maximize efficacy and minimize potential harms, including exacerbating health disparities. Core elements of the PPE include a focused history & physical (H&P) and the 12-lead electrocardiogram conducted by well-trained clinicians, with readily accessible expert consultation for secondary evaluation when necessary. As no primary prevention screening approach provides absolute protection against SCA, a well-developed emergency action plan is an essential part of comprehensive cardiovascular care for athletes of all levels.

Discussion

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Cite This Study

Krishnan et al. (2026) studied Sudden cardiac arrest / cardiovascular conditions in competitive athletes. Pre-participation cardiac screening (focused history & physical and 12-lead ECG) was evaluated on Identification of previously unrecognized cardiovascular conditions that may increase the risk of sudden cardiac arrest/death during sports participation. Pre-participation cardiac screening using focused H&P and 12-lead ECG alongside an emergency action plan is recommended to identify cardiovascular risks and address SCA in competitive athletes.

synapsesocial.com/papers/6af88c410e4d8f4b089c1b2d https://doi.org/10.1249/mss.0000000000004090

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Task Force 2: Clinical Considerations for the Pre-Participation Cardiac Evaluation of Competitive Athletes

Key Points

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Task Force 2: Clinical Considerations for the Pre-Participation Cardiac Evaluation of Competitive Athletes

Key Points

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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