Preventing Sudden Cardiac Death in Young Athletes
By Khalid Sheikh, MD, MBA // August 17, 2013
WHY IS THERE STILL A SCREENING DEBATE?
ABOVE VIDEO: KOAT-TV (Albuquerque, New Mexico) Health Beat’s Dr. Barry Ramo opines on the value of including routine ECG screening in pre-participation evaluations of teen athletes.
BREVARD COUNTY • VIERA, FLORIDA – This weekend I will be attending a memorial event for a local high school soccer player who died five years ago of sudden cardiac death (SCD).
The untimely death occurred during soccer practice just days before his 16th birthday. He had absolutely no knowledge or symptoms prior to suggest he was anything but an extremely fit young man. His death gripped and shocked our community, and each memorial service that has occurred since has only served to reinforce not only the magnitude of the tragedy, but also that it was very likely preventable.
U.K. RESEARCH: SCREEN YOUNG ATHLETES WITH ECG
This month, at the annual European Society of Cardiology meetings in Rome, researchers from the U.K reported on their experience in using a combination of medical history, a focused physical examination and a 12-lead ECG in screening young athletes.
An ECG is a 15-second, painless exam that records the electrical impulses of the heart using sticky electrodes applied to the chest.
The examinations in the U.K. were conducted during 2007-2012 in over 15,000 athletes between the ages of 14-35. Over half of the athletes were immediately cleared to participate in sports after initial screening, without further testing needed. None have yet suffered any cardiac event.
Among the 6,598 athletes that failed initial screening, 5,415 had some suspicious symptoms but a normal ECG. Not a single one of these athletes were subsequently confirmed to have serious heart problems.
However, 1,183 athletes had suspicious ECG’s, of whom 67 (6%) were found to have serious heart problems. The investigators concluded that had ECG’s not been routinely performed, all of these athletes would have had undetected heart disease and thereby put themselves at risk for SCD by participation in sports.
ECG IDENTIFIES OVER 90 PERCENT OF AT-RISK ATHLETES
In the United States there are an estimated 300 SCD’s annually in high school athletes, occurring from an estimated population of over 10,000,000 participants.
The vast majority of SCD’s occur in athletes with latent or hidden heart disease. Only 3% of cases occur in individuals with normal hearts.
In nearly all cases, the individuals afflicted with these conditions are without symptoms. Routine medical history and physical examinations such as those recommended by most State High School Athletic Associations will detect only 3% of athletes who are at risk. However, when a routine ECG is added to a physical examination, multiple studies now confirm that over 90% of at-risk athletes can be identified.
WHAT COST A YOUNG LIFE?
ECG screenings are supported by the International Olympic Committee, as well as both the European and Japanese Cardiology Societies. Most European countries now mandate ECG screenings of middle and high school athletes. However, such screenings are neither required nor considered standard of care in the United States.
Most health insurance companies do not cover routine ECG exams for screening in children and adolescents. The primary reason for this is that the costs associated with routine screenings are considered prohibitive. It is estimated that routine screening of high school athletes would potentially cost the nation $ 2 billion annually. These costs are due to not only the cost of the ECG examination, but also because of the costs of following up abnormal ECG examinations with more sophisticated cardiac testing.
Undoubtedly, as health care costs continue to spiral upward, the debate over the cost-effectiveness of a number of medical procedures is under scrutiny. However, as the evidence mounts that simple ECG exams can detect potentially fatal hidden heart problems in the young athletes of our country, there should no longer be a debate about the additional value of ECG screening as being cost-effective. If you have the misfortune to attend just one memorial for a young athlete felled from SCD, it is one too many.
For more information, get the book Don’t Let Your Heart Attack!, available on Amazon, Barnes & Noble and iTunes.
ABOUT THE AUTHOR
Dr. Sheikh, a member of Health First Physicians Group, directs a cardiology practice specializing in lipid management and cardiovascular disease prevention, treatment and reversal in Cocoa Beach, Florida. He was a Professor of Cardiology at Duke University before entering private practice, and is currently on the clinical faculty at the University of Central Florida College Of Medicine. Dr. Sheikh, who was recognized by the Consumers’ Research Council of America as one of America’s Top Cardiologists, is board certified in both Internal Medicine and Cardiovascular Diseases, and is a Fellow of the American College of Cardiology. He is also a certified clinical lipid specialist, board certified in adult echocardiography and has completed level I training in cardiac CT imaging. He has served as the principal investigator in over 100 national and international clinical research trials, and authored over 150 scientific abstracts, peer-reviewed journal articles, book chapters and subject reviews.
For more information about Don’t Let Your Heart Attack and Dr. Sheikh’s practice go to SheikhHeartCare.com