Study: Heart setbacks from COVID-19 unlikely in athletes

Findings suggest most college athletes with mild or asymptomatic cases can safely return to play without more cardiac tests.

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While the lasting impact of COVID-19 on hospitalized patients in the general population is common and associated with adverse cardiac outcomes, evaluations of more than 3,000 collegiate athletes revealed no adverse cardiac events after COVID-19 infections.

This indicates that asymptomatic and mildly symptomatic athletes can safely return to play without additional cardiac testing, according to a study published today in the American Heart Association’s flagship journal Circulation. 

“Most athletes with no symptoms or mild illness from SARS-CoV-2 can return to sports safely without additional cardiac testing as long as they feel good on return to exercise and don’t have cardiopulmonary symptoms like chest pain,” said Dr. Jonathan Drezner, director of the UW Medicine Center for Sports Cardiology and a co-principal investigator on the study.

The observational cohort study included data from 42 colleges and universities. Researchers assessed the prevalence, clinical characteristics, and outcomes of SARS-CoV-2 cardiac involvement among collegiate athletes in the United States. Data were collected from Sept. 1 to Dec. 31, 2020.

Out of more than 19,000 athletes screened for SARS-CoV-2 infection, 3,018 tested positive and underwent cardiac evaluation.  A total of 2,820 athletes underwent at least one element of cardiac ‘triad’ testing [12-lead electrocardiography (ECG), troponin, and/or transthoracic echocardiography(TTE)] followed by cardiac magnetic resonance (CMR) if clinically indicated; 198 athletes underwent a primary screening CMR. Overall, the prevalence of probable or definite cardiac involvement from SARS-CoV-2 infection was 0.4%-1.5%. The diagnostic yield for probable or definite cardiac involvement was 6.7 times higher for an CMR obtained for clinical reasons (10.1%) versus a primary screening CMR (1.5%). The odds of having cardiac involvement was also 3.1 times higher in athletes with cardiopulmonary symptoms.

Registry created to monitor cardiac conditions in NCAA athletes

Sports medicine and cardiology experts at Harvard and the University of Washington School of Medicine formed the Outcomes Registry for Cardiac Conditions in Athletes (ORCCA), a national research database to track COVID-19 cases and heart-related effects in NCAA athletes. The goal is to improve screening and understanding of heart ailments in college athletes with prior COVID-19 infections.

“The very timely and largely reassuring data coming from the ORCCA registry were made possible by an amazing collaborative effort between the sports medicine and sports cardiology communities,” said Dr. Aaron Baggish, co-principal investigator from the Massachusetts General Hospital in Boston. “It is anticipated that ORCCA will continue to shape the way we protect the health of young competitive athletes well beyond the end of the COVID-19 pandemic.”

The American Heart Association and the American Medical Society for Sports Medicine joined forces earlier this year to accelerate a critical new research initiative studying cardiac conditions in athletes, in part to speed new insights into the impact of COVID-19 to the cardiovascular system of college athletes and safety of return to play after diagnosis. The registry will ultimately become a deep knowledge base on cardiac disease in athletes beyond the pandemic. 

Developed with the NCAA's participation, the registry currently has more than 60 schools contributing data. Schools interested to participate or learn more can email

The research team is led by Baggish, Drezner, and Dr. Kimberly Harmon, a family medicine and sports medicine practitioner at UW Medicine in Seattle.

[Display photo "NCAA 2021: George Mason vs. Richmond -- January 9, 2021," by Patrick Rouin / All-Pro Reels Photography licensed under CC BY 2.0.]

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