The AHA 14-element history and physical for young competitive athletes, and where the ECG fits
Healthy young people 12 to 25 years old. Paraphrased; class and LOE as published.
| Class | Recommendation | LOE |
|---|---|---|
| I | Use the AHA 14 elements (and guidance such as the AAP Preparticipation Physical Evaluation monograph) within a full history and physical. | C |
| I | Pursue standardised questionnaire forms for US high school and college athletes. | C |
| IIb | A 12-lead ECG (or echocardiogram) added to the history and physical may be considered in relatively small cohorts of healthy 12- to 25-year-olds, athletes or not, with close physician involvement and enough quality control. | C |
| III | Mandatory, universal mass ECG screening of large general populations of 12- to 25-year-olds (including US-wide), athletes or not: not recommended. | C |
| III | Large-scale universal screening of 12- to 25-year-olds by history and physical alone (including US-wide): not recommended. | C |
All ages. Defined wording, not class and LOE. Paraphrased.
| Wording | Consideration |
|---|---|
| Should | Treat cardiac screening as one part of sudden cardiac arrest prevention, aimed at finding unrecognised disease so it can be managed. |
| Should | Pair good primary screening with secondary evaluation, funded and organised for a systematic downstream workup. |
| Should | Take the cardiovascular history and examine: this finds symptomatic athletes and family histories suggesting inherited disease. |
| Reasonable | Add a resting 12-lead ECG: it finds more disease in asymptomatic athletes than the history and physical alone, but does not detect AAOCA or aortopathy. |
| (statement) | ECG-based screening needs clinicians trained in contemporary athlete-specific ECG criteria, to limit harm (for example from false positives). |
| (statement) | Imaging, exercise testing and ambulatory rhythm monitoring: insufficient data for added value in primary screening of asymptomatic athletes. |
| Should | Develop, practise and use an emergency action plan (CPR training, prompt AED access, coordinated transport) everywhere athletes train and compete. |
The 2025 scientific statement (Kim et al.) presents itself as the update to the 2015 eligibility and disqualification series. It uses defined wording (should, reasonable, and so on) instead of class and level of evidence, and applies to athletes of every age, not only 12 to 25.
An ECG raises the sensitivity of the evaluation to about 94%, at the cost of specificity. Contemporary criteria still give more false positives in Black athletes. An ECG cannot detect anomalous aortic origin of a coronary artery, aortopathy, substantial valve disease or adrenergically mediated arrhythmias.
The 2025 statement replaces "disqualification" with shared decision-making about sports participation. In higher-risk scenarios, hold the athlete out of competition until the evaluation and guideline-directed treatment are done.
The ACC opposes state laws requiring universal ECG screening of competitive athletes; it still calls the ECG a reasonable addition where expert reading and follow-up exist.
Its 2026 report (Kim et al.) keeps the ECG as a reasonable addition only where expert interpretation and downstream care are available to every screened athlete, and names an effective emergency action plan, with early defibrillation and CPR training, as the legislative priority.