Key takeaways:  

  • The first international statement on cardiac evaluation in the Armed Forces has been published.  
  • The rate of sudden cardiac death appears higher in military recruits than in athletes.
  • Cardiac screening may be appropriate for all new military recruits and should be performed in those in high-hazard occupations. 

Sophia Antipolis, France – 1 July 2026: The first comprehensive framework to guide cardiac evaluation in the Armed Forces has been issued by the European Association of Preventive Cardiology (EAPC) of the ESC. Published today in the European Journal of Preventive Cardiology, [1] the statement was written by international experts from Europe, North America and Australia. 

The risk of cardiac events in individuals with underlying heart disease may increase during intense physical activity. In athletes, cardiac screening, including ECG-based testing, has proved very useful in identifying conditions associated with sudden cardiac death or cardiac arrest. According to the authors of the new statement, developing recommendations on cardiac evaluation in military populations was the next logical step. 

First author, Surgeon Captain Doctor Mark Abela, from Mater Dei Hospital and the University of Malta, Msida, Malta and the Armed Forces of Malta, explained: “Military personnel often work in physically and psychologically demanding conditions, with additional environmental stressors such as extreme heat, cold and altitude. Undetected cardiovascular disease can have profound operational, safety and morale consequences.” 

From the limited data available in military recruits, it appears that the rate of sudden cardiac death is substantially higher (8−11 per 100,000 recruit-years) compared with athletes (1–2 per 100,000 athlete-years). [1] Despite this, results from a recent EAPC survey found that pre-participation cardiovascular screening of military personnel differed widely across the 14 countries studied. [2] Only 71% of the nations reported the ECG-based screening of recruits. 

According to the new statement, cardiac screening − including a health questionnaire, physical examination and a resting ECG − may be appropriate for all new military recruits, irrespective of their role. Cardiac screening should be performed in all individuals engaging in high-hazard duty occupations, such as those working in challenging environmental conditions. Furthermore, military personnel aged 40 years or older should have a cardiovascular risk assessment with validated cardiovascular risk calculators in addition to standard cardiac screening. 

“The published statement establishes a standardised approach to cardiovascular screening in the military, with the aim of encouraging ECG-based screening algorithms and promoting consistency to improve the early detection of life-threatening conditions,” concluded Doctor Abela. 

ENDS