Mass screening young athletes for hidden heart defects using electrocardiograms isn’t justified by the evidence, according to a scientific statement released September 15 by the American Heart Association and the American College of Cardiology. Universal EKG screening would potentially cost about $2 billion in the first year and risk both false-negative and false-positive results, the authors caution.
The recommendation is the latest chapter in an ongoing debate over whether widespread EKG screening could prevent sudden cardiac death (SN: 4/5/14, p. 22). Some countries already employ universal EKG screening programs for sports participation, and advocates have argued that the practice could identify young athletes in danger before they collapse. One frequently cited estimate suggests that 1 out of every 200,000 high school athletes dies suddenly in the United States each year.
However, a committee made of 18 specialists from across the country concludes that adding an EKG, which measures the electrical rhythm of the heart, to routine screening wouldn’t lower mortality. Only one study of athletes in Italy has found a reduction in mortality, the authors say, and those results have not been replicated.
The recommendations appear in the journal Circulation.
Previous recommendations on screening were published in 1996 and 2007. The new document expands the focus beyond athletes to consider all healthy adolescents and adults between ages 12 and 25.
Sudden death is a rare event. But athletes have garnered the most visible public concern over the condition, heightened by media reports of fatalities during practices or games. However, the committee points out that the genetic susceptibility for sudden death may be equally high or low in both athletes and nonathletes. If EKG screening is assumed to be beneficial, ethical questions arise if routine testing occurred only in sports. Athletes, the authors note, would “have the advantage of cardiovascular screening, while others who choose not to be involved in such activities (but may be at the same or similar risk), are in effect excluded from the same opportunity.”
In fact, the focus on sports screening has skewed public discussion, said committee member Benjamin Levine, head of the Institute for Exercise and Environmental Medicine at University of Texas Southwestern Medical Center and Texas Health Resources in Dallas. “There are kids who die, but they don’t die playing sports,” he said.
Committee chairman Barry Maron, director of Hypertrophic Cardiomyopathy Center at the Minneapolis Heart Institute Foundation, said the group’s opinion concerns universal screening. The statement “clearly opens the door for any kind of screening that would be in smaller groups,” he said, such as individual teams or schools. “The only thing excluded is national screening.”
The recommendations urge continued use of the medical history and physical exam, with a 14-point checklist to flag potential problems. Should that exam then lead to concerns, an EKG or further tests would be justified. “Do I think [EKGs] are important and helpful? Absolutely. In the right context with the expertise in assessing that specific test, and knowing the limitations,” says Silvana Molossi, a pediatric cardiologist at Texas Children’s Hospital in Houston and cochair of the American College of Cardiology’s sports and exercise cardiology council. Not an author on the statement, Molossi generally agrees with its conclusions.
She and others also agree that one measure proven to save lives should be more widespread: automated external defibrillators. The devices should be installed and maintained in public places, sports arenas and schools, the recommendations’ authors say. If used immediately, a defibrillator can resuscitate someone in cardiac arrest.