A joint American College of Cardiology/American Heart Association Scientific Statement presents the Tactical Clinical Management (TCM) framework as a structured approach to evaluate cardiovascular risk in tactical athletes. The statement is the first comprehensive document to combine evidence-based cardiovascular care with the occupational demands, mission requirements and public safety considerations unique to this population. The guidance recognizes that clinical decisions for tactical athletes must account for broader implications of a cardiovascular event beyond the individual, including impacts on teammates, mission success and public safety.
Tactical athletes encompass military personnel, firefighters, law enforcement officers, emergency medical responders, astronauts and pilots. The statement emphasizes that these professionals perform mission-specific duties in unpredictable, high-stress situations and/or extreme conditions that alter typical cardiovascular risk assessments and management strategies.
The authors recommend routine preparticipation screening for all tactical athletes, beginning with a detailed history and physical examination. The statement specifies that an ECG should be performed in tactical athletes under 40 years old who are exposed to significant cardiovascular strain or who serve in mission-critical roles. Performing an ECG is also described as reasonable for other tactical athletes; clinicians should weigh the occupational context and individual risk when deciding on testing.
Screening aims to identify known cardiovascular disease and risk factors that are prevalent among tactical athletes, including hypertension, hyperlipidemia, obesity, Type 2 diabetes and smoking. The statement does not prescribe a single universal testing battery for all tactical athletes but encourages individualized evaluation guided by the TCM framework.
Fitness-for-duty determinations should extend beyond personal health and consider potential consequences for team members, operations and public safety. The statement urges clinicians to balance medical evidence with mission-critical requirements and to document reasoning for clearance or restriction decisions.
Key elements to weigh in fitness-for-duty decisions include the specific duties and environments associated with the role, the immediacy and predictability of strenuous exertion, the availability of co-worker support, and the potential for sudden incapacitation to compromise missions or endanger others. Decisions should be individualized and made in collaboration with occupational leaders and, when appropriate, with input from specialists.
The guidance details that clinicians should consider the cardiovascular implications of a range of conditions commonly relevant to tactical athletes, including cardiomyopathies, arrhythmias, congenital heart disease, coronary artery disease, valvular disease, myocarditis and anticoagulation status. For these conditions, the statement emphasizes the need for tailored management plans and ongoing monitoring, recognizing that the interaction between disease and occupational demands may change over time.
The document highlights that tactical athletes often serve across decades and may participate at older ages than competitive athletes, a factor that can influence disease prevalence and monitoring strategies. The statement does not provide specific monitoring intervals for every condition; clinicians are directed to apply the TCM framework and specialty guidance when determining follow-up and surveillance.
Operational and environmental exposures that increase cardiovascular workload or risk are central to the statement’s recommendations. Examples cited include heat exposure, dehydration, altitude, diving and aviation exposures, working while carrying heavy equipment, high-speed or collision-prone tasks, and responding to emergencies under intense psychological stress. These factors can magnify cardiac demand and should be integrated into risk assessment and clearance decisions.
Clinicians are advised to consider role-specific exposures and the likelihood of encountering extreme conditions when formulating recommendations or restrictions. The statement underscores that occupational context may justify different thresholds for testing, clearance and temporary or permanent duty limitations.
Recognizing that screening cannot prevent all sudden cardiac events, the authors recommend that organizations maintain robust Emergency Action Plans and ensure rapid access to AEDs. Preparedness measures should include clear protocols for medical emergencies, training for coworkers in recognition of cardiac events and immediate response procedures designed for the operational setting.
The statement highlights that accessible emergency care and response readiness are essential complements to screening and clinical risk management for tactical athletes.
The statement’s authors call for additional research to improve care of tactical athletes. Priorities identified include the development of registries, the validation and improvement of screening strategies, and creation of cardiovascular risk prediction models tailored specifically to tactical athletes. The guidance notes that further evidence is needed to optimize screening approaches and fitness-for-duty algorithms for diverse tactical populations.
The scientific statement was published simultaneously in JACC and Circulation on Sept. 3, 2026. The authors point readers to the full manuscript in those journals for complete details and reference the need for multidisciplinary collaboration across tactical specialties, sports cardiology and other cardiovascular disciplines.
Additional resources and translations were noted by the authors, and organizational contacts for media and public inquiries are provided in the original statement. The statement reinforces that cardiovascular care for tactical athletes must integrate clinical evidence with the unique occupational and public safety considerations these professionals face.