Cardiovascular disease (CVD) is the leading medical cause of duty-related deaths among tactical athletes, including military personnel, firefighters, law enforcement officers, emergency medical responders, astronauts and pilots. These individuals face unique physical and environmental demands that can increase cardiovascular risk and require specialized approaches to evaluation and care, according to a new joint American College of Cardiology/American Heart Association Scientific Statement simultaneously published today in the American College of Cardiology's flagship journal JACC and the American Heart Association's flagship, peer-reviewed journal Circulation .
The new scientific statement, "Clinical Considerations for the Care of the Tactical Athlete With Cardiovascular Abnormalities," is the first comprehensive document that offers guidance to help clinicians evaluate cardiovascular risk and assess the unique characteristics of tactical athletes. The statement introduces Tactical Clinical Management (TCM), a new framework that combines evidence-based medical care with occupational demands, mission requirements and public safety considerations when evaluating a tactical athlete with cardiovascular disease or increased cardiovascular risk.
It is estimated that more than 4 million Americans are currently serving as tactical athletes who are trained to perform demanding, mission-specific duties in unpredictable, high-stress situations and/or extreme conditions. Their cardiovascular care requires considerations beyond those typically applied to competitive athletes or the general population because these professionals often work in high-risk environments where sudden incapacitation can affect teammates, mission success and public safety.
"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," said Elizabeth H. Dineen, DO, FACC, FAHA, chair of the statement's writing group. "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."
Vice Chairs Benjamin D. Levine, MD, FACC, FAHA, and Mark C. Haigney, MD, FACC, FAHA, also note the critical importance of this document and unique contributions from experts representing a wide array of tactical disciplines, sports cardiologists and other CVD specialists.
Tactical athletes may be required to perform unpredictable strenuous physical activity while carrying heavy equipment, operating in extreme temperatures, working at altitude, flying aircraft, diving underwater or responding to emergencies under intense psychological stress, factors that can significantly increase cardiac workload.
Service time for tactical athletes may span decades, often with older ages of participation compared to competitive athletes. These demands can increase CV strain and influence decisions.
The authors note that traditional cardiovascular risk factors, including hypertension, hyperlipidemia, obesity, Type 2 diabetes and smoking, remain highly prevalent among tactical athletes.
"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," Dineen said.
Key recommendations and considerations include:
- Use the new Tactical Clinical Management (TCM) framework to support individualized evaluation and cardiovascular risk assessment within the context of occupational requirements and demands.
- Preparticipation screening is critical for all tactical athletes and includes a history and physical examination. An ECG should be performed in tactical athletes under 40 years old exposed to significant cardiovascular strain or in mission-critical roles and is reasonable for other tactical athletes.
- Fitness-for-duty determinations should not only account for individual health risks but also for potential risks to team members, mission success, and public safety.
- The cardiovascular implications of conditions such as cardiomyopathies, arrhythmias, congenital heart disease, coronary artery disease, valvular disease, myocarditis and anticoagulation status, should be considered. The need for ongoing monitoring is emphasized.
- Operational and environmental factors, including heat, dehydration, altitude, diving and aviation exposures, collision risk, and availability of emergency medical care should also be considered.
- Organizations should maintain Emergency Action Plans and rapid AED access because screening alone cannot prevent all sudden cardiac arrests.
The statement authors highlight that more research is needed, including the development of registries, improved screening strategies and cardiovascular risk prediction models tailored specifically for tactical athletes.
Additional Resources:
- After Sept. 3, 2026, view the manuscript online in JACC and Circulation
