There is no good evidence to support screening young athletes to prevent sudden cardiac arrest, concludes a new analysis published in the BMJ. The analysis also raises new and troubling questions about a key Italian study that has been the main study used to buttress ECG screening in this setting.
The BMJ article summarized a Health Technology Assessment on cardiovascular pre-participation screening commissioned by Belgian authorities. The group wrote that screening is unlikely to save lives "because of the poor detection rate and the uncertain effectiveness of the management of the diseases thus identified in asymptomatic people."
Moreover, they emphasized, screening "induces harm because of the high number of false positive test results leading to temporary or lifelong disqualification from competitive sports, psychological and financial harm, and medical follow-up and treatment with unknown benefit. In addition, it leads to young people avoiding exercise known to be beneficial to their overall health."
The Belgian authors were sharply critical of a group of Italian authors who have been passionate advocates of pre-participation ECG screening. In a 2006 Journal of the American Medical Association article, Domenico Corrado, MD, PhD, and colleagues concluded that the rate of sudden death in young athletes plummeted in the Veneto region of Italy after the adoption of nationwide systematic ECG screening program.
"Some of the concerns about the Veneto study might be clarified if the Italian investigators would provide access to additional unpublished data," wrote the Belgians. They reported that their own requests for more information have "remained unanswered."
U.K. researchers have also sought to examine the Italian data. In an accompanying BMJ news story, Deborah Cohen reported that the British health secretary, Jeremy Hunt, wrote to Italy's health minister seeking "evidence on the effectiveness of screening for sudden cardiac death" for an update by the UK National Screening Committee." But Hunt reportedly "did not obtain the information he requested."
Corrado told the BMJ's Cohen that "he had been asked by Belgian researchers for more data but that he had told them 'we were analyzing new data on sport-related mortality in the Veneto region of Italy during the last decade and that updated data were not available for public release yet.' "
Across the world, there is an extremely broad variation in guideline recommendations and clinical applications. The American Heart Association recommends a personal and family history along with a physical examination for pre-participation screening. Some schools and leagues have much more rigorous programs incorporating ECG and even echocardiographic screening. The European Society of Cardiology recommends ECG testing.
ECGs, according to the Belgian authors, can help prevent a large number but by no means all cases of sudden cardiac death. But ECGs will also produce a large number of false positives, they note.
Additional Reading:
- ACC And AHA Don't Recommend Routine ECG Screening of Young People
- Mobile Cardiovascular Screening Programs Come Under Fire
- Model Finds High Cost for ECG Screening of Athletes
- USPSTF Maintains Recommendation Against ECG Screening of Asymptomatic Low-Risk Adults
- Guest Post: The Dark Side of EKG Screening in Athletes
- Half the News That's Fit To Print: NY Times on ECG Screening for Student Athletes
- Screening Young Athletes: To ECG or Not To ECG?
- Study Finds No Benefit in Routine ECG Screening for Young Athletes
- Shedding Light on the Hearts of Pro Basketball Players