Universal heart screening for all athletes? Not so fast, cardiologists warn
Legislative mandates requiring all competitive athletes to undergo electrocardiogram (ECG) screening will likely do more harm than good, according to a new statement from the American College of Cardiology (ACC). The group emphasized that such mandates may sound reasonable in theory, but modern U.S. health systems were not built to handle such a rise in demand. Also, universal mandates are sure to result in much higher healthcare costs and other unintended consequences.
Mandates for universal ECG screening have started to gain momentum in the United States—one in Florida got signed into law in 2025, for example—as an attempt to reduce the risk of athletes going into sudden cardiac arrest (SCA). The ACC saw this trend unfolding and wanted to step forward and share its own perspective on the concept of universal screening.
The new statement represents a collaboration between ACC leaders and a variety of experts in pediatric sports cardiology. It has been published in JACC, the ACC’s flagship journal.[1]
“Although legal mandates for ECG screening of competitive athletes are practical in some countries, in the United States, cardiac healthcare policies for competitive athletes should be principally evidence-based intervention(s) that improve health outcomes among all athletes while not increasing the risk for unintended harm(s),” wrote first author Jonathan H. Kim, MD, MSc, a cardiologist with Emory University School of Medicine, and the rest of the statement’s writing committee. “Because of growing interest in legislative screening mandates, the purpose of this document is to provide the official ACC policy position on ECG screening implementation.”
Kim et al. wrote that an emergency action plan (EAP) ensuring access to immediate cardiopulmonary resuscitation and early defibrillation after SCA is the only intervention proven to save the lives of athletes. Universal mandates like the one passed in Florida could draw attention and resources away from EAPs. In addition, the group wrote, it has yet to be proven that universal screening would have a mortality benefit.
One key takeaway from the ACC’s statement is the impact these mandates could make on a healthcare system. Requiring so many additional ECGs to be interpreted, for example, could result in rushed or inaccurate interpretations. Also, the costs associated with such a policy would likely be in the range of $10 million per year for a medium-sized state such as Georgia.
“Legal mandates for large-scale ECG screening of competitive athletes will perpetuate unintended harms to competitive athletes,” the writing committee concluded. “In contrast, an effective EAP, including access to early defibrillation and cardiopulmonary resuscitation education and training, is the only intervention that is established as lifesaving for all young individuals at risk for SCA. Widespread development and implementation of effective EAP should represent the priority in legislative mandates related to the care of young competitive athletes.”
Click here to read the full statement.
Michael has more than 19 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.