Sports Medicine Research: In the Lab & In the Field: Screening for Sudden Cardiac Death Before Participation in High School and Collegiate Sports: American College of Preventive Medicine Position Statement on Preventive Practice (Sports Med Res)
Friday, July 5, 2013

Screening for Sudden Cardiac Death Before Participation in High School and Collegiate Sports: American College of Preventive Medicine Position Statement on Preventive Practice

Screening for Sudden Cardiac Death Before Participation in High School and Collegiate Sports: American College of Preventive Medicine Position Statement on Preventive Practice

Mahmood S, Lim L, Akram Y, Alford-Morales S, Sherin K; ACPM Prevention Practice Committee. Am J Prev Med. 2013 Jul;45(1):130-3. doi: 10.1016/j.amepre.2013.04.002.

The American College of Preventive Medicine (ACPM) has released a new position statement regarding the screening for sudden cardiac death before participation in high school and collegiate sports. The document is a nice complement to the Inter-Association Task Force for Preventing Sudden Death in Secondary School Athletics Programs: Best Practices Recommendations. The statement includes a concise paragraph describing the College’s current position and then provides additional information in four brief sections: 1) background, 2) support evidence/areas of incomplete or lacking data, 3) recommendations of other societies, 4) rationale for the College’s current position.


5 comments:

TG said...

I find it interesting how generally speaking, the European countries are for ECG testing all youth athletes, whereas the US organizations are generally opposed to it.

Personally, I do not think that ECG testing is practical for a few reasons.
1. Quite simply, who will pay for it? Youth hearts grow and change so much year to year, it would require retesting each year to properly catch any potential anomalies, and the costs of these tests would add up very quickly.

2. The false positive rate is too high. Even if we take what could be generally accepted as acceptable, a 5% false positive rate, what would we do with that 5% of the 10 million athletes stated in the statement? Do we disqualify them from sport for no reason, predisposing them to other conditions like obesity from inactivity? Or do we allow them to participate and prepare for the situation when they do collapse from SCA, which as as an athletic trainer, one should be prepared for anyways, making the test a moot point since you cant predict SCA and just prepare for the worst.

3. The incidence of SCD is relatively low, and the cost of testing is too high. While it is impossible to put a value on human life, I personally think that the $2.0 billion estimate stated in the statement could be better spent. Take that money and put it towards having athletic trainers in all of these youth settings. Now, if there is an incidence of SCA, there is a trained professional there to save the athlete's life. The AT being present will also be able to address all of the other causes of sudden death in sport as well, making it a much better investment, in my opinion, than testing that may not represent the true condition and you can not predict the incidence of anyways.

Jeffrey Driban said...

Hi TG:
Great points. The argument you make in the first point is very common and valid. The counterargument, as you noted, is what is the value of each life saved? Harmon et al has offered a good compromise: screen the high-risk populations (http://sportsmedresearch.blogspot.com/2011/04/incidence-of-sudden-cardiac-death-among.html).

The false positive rate is relatively high since we're talking about a large population but this wouldn't exclude people from sports but instead it would trigger even more expensive testing to further assess the patient. This may delay the athlete's participation in sports but this would be similar to having a positive special test and then opting for an MRI. It's expensive but it has precedent.

You may also be interested in "Return to play? Athletes with congenital long QT syndrome" http://sportsmedresearch.blogspot.com/2013/02/long-QT-syndrome-return-to-play.html

Shannon Snell said...

I totally agree that it is impractical because the athlete's heart keeps growing and we do not know when the optimal age would be to test for abnormalities which can lead to SCD. Along with that is the money portion. There is no money out there to cover the cost for doing these screening on high school and collegiate athletes. I was recently at a conference where a presenter talked about this and there false positives for hypertrophic cardiomyopathy because an athlete's heart muscle will get larger due to the exertion of their sport. When they find that they of course pull the athlete out to check them out because they think they have a disease that will kill them when it is a case of their body adapting to handle the stress of the sport on the human body. Along with the false positive you can also receive false negatives. EMG's and H&P's do not always catch every cardiac problem that can lead to SCD. So at this point in time all we can do is to educate people on what it is and what to do if it happens. Hopefully there will be an athletic trainer or someone trained in what SCD is and what to do if it ever occurs. If someone can get money to do studies to see if there is a way to make these studies more effective and less costly then in future I think we could start screening all the high school and collegiate athletes. However, at this time I do not see it as being practical right now.

Zach Johnson said...

If there is available funding of roughly 2.0 billion dollars, I am on board to have the youth athletes tested. But the adolescent heart changes every year. The same 2 billion dollars would need to be spent every year for this to be able to happen. I just don’t think that this is possible.
I think that the compromise that Harmon et al offers is something that could work. There is no logistics at this point to be able to provide the mass screening for all youth athletes. We can find a starting point, such as screening the high-risk population. Moving forward, we can continue to collect new data to find out what is the best practice possible to help prevent SCD as well as being logistically and financially possible.

Erika Spudie said...

This is such a difficult issue, that it's often easy to brush it off and say that all we as sports medicine professionals can do is to be prepared. However, these athletes who are in the athletic setting at the time won't always be there; their condition may manifest itself in a less formal athletic setting in the future, where there may be no rescue available. By spending money elsewhere and pinning cardiac screening as "too impractical", I think we are doing those unknowingly afflicted athletes a disservice. Personally, I've seen the aftermath of a SCD in a sports team and the emotional toll it takes on those left behind, which alters my point of view. It's hard to compare money to a human life. While it is definitely true that medical professionals should be prepared should continually push for Athletic Trainers and AEDs in every athletic setting, we should still be pushing for change in the arena of cardiac screening. I think one of the biggest things that we as professionals can do is emphasize the importance of family and personal history to our athletes (or their guardians in the case of high schoolers). It is important to emphasize to young athletes especially the importance of reporting chest pain and syncope events to their AT.

While we will never prevent death, the battle to prevent SCD in young athletes (as well as old) is one of the most important things we can study, I believe. Although I have no solution for the expense of EKGs & other testing methods, I know that increasing awareness about the inheritance of cardiac conditions among patient populations is important.

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