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SCA is the leading medical fatality for student athletes, estimated to steal a young life every three days in the US. Considering that it doesn't just affect athletes, truely this ratio is even higher.
I wish it were as simple as to say all children need screened and all locations need a defibrillator period, but the reality is, it is not that simple. Resolutions need addressed from many angles.
Trying to play the devil’s advocate for both sides is not a simple task and I will probably sound more as the protagonist as opposed to the antagonist for heart screening of young people/athletes.
The medical debate for heart screening of young people/athletes has been around for many years. Medical professionals have various opinions on the matter so I am going to try to explain some controversy surrounding the issue, as I understand it.
In my heart of hearts I wish that every child, teen, young adult could have a full cardiac evaluation every few years so that families will not have to endure what we have. The reality is that is not possible. So what can be done to reduce cardiac fatalities in young people/athletes?
Different cardiac tests determine different things. It is like going through or pulling back layers of something to find different things. What is the acceptable or “cost effective” price to sort through the layers is yet to be determined. Medical service providers and insurance companies establish “cost effective” structures to determine what costs should be allowed for preventative testing.
As a parent who lost a child, “cost effective” is not in my vocabulary. But that is my world, my vocabulary and not the real world.
So let’s cut to the chase with some of the heart screening debate issues.
- It is not cost effective to mandate cardiac tests.
- Should it be a mandate? Why can’t people have the choice to make an informed decision?
- If a mandate were made for cardiac tests the current medical community could not handle the influx of patient services.
- Currently, medical service providers are not prepared to take on a large amount of pediatric cardiology specialty testing, however with minimal training, other medical personnel can perform certain tests with oversight.
- What tests would be considered cost effective?
- There is not a one test fits all option. Full cardiac evaluations are not cost effective but communities may be able to find ways to create cost effective screenings. Primarily EKGs and echocardiograms are the most common tests that can identify some of the life threatening heart conditions. Recent research has shown community based programs can be completed "cost effectively".
- If the trained professionals have a hard time determining heart problems, how are those with less specialty training going to find heart problems?
- Education is needed. Medical professionals say with minimal information they would feel comfortable performing EKG testing. While it is true tests are not 100% reliable and some problem may go undetected, in Europe and Japan around 70-80% of problems have been identified through screenings.
- Does testing provide a false sense of security?
- It may, as does the current standard of family heart history and the current physicals.
- If EKGs tests are performed, what are the unified standard guidelines for rhythms in children, teens, young adults, athletes?
- There is a need for medical research as to what the recommended standards should be; this is something that can be accomplished with a panel. Medical professionals can currently use past research as a basis.
- Tests have false positive and false negative results.
- There are further cardiac tests that can be performed to search for cardiac problems. So, the choice should be the patients, you may need to spend unnecessary money on tests or the athlete may be sidelined for a season but that cost is minimal compared to losing a young life.
- Current Screening Programs, what are they finding?
- Most programs are identifying about 10% patients need further evaluation. With further research and investigative panels, improvements can be made. Heart problems are being identified and lives have been saved.
Can they be done? ABSOLUTELY
Would we be able to prevent all fatalities? NO
Would we be able to reduce fatalities? YES
To what extent? AS OF NOW, WE DON’T KNOW
At what cost? AS OF NOW, WE DON’T KNOW
CERTAINLY, WE CAN DO MORE, WE CAN DO BETTER, AND YOUNG LIVES ARE WORTH IT!
AHA guidelines acknowledge the value of ECG screening but do not endorse a national program of screening due to financial/operational concerns. They state: “this view represents a perspective on large-scale national screening programs and is not intended to actively discourage individual local efforts."
- Maron BJ, Shirani J, Poliac LC, Mathenge R, Roberts WC, Mueller FO. Sudden death in young competitive athletes: clinical, demographic and pathological profiles. JAMA. 1996;276:199-204.
- Maron BJ, Gardin JM, Flack JM, Gidding SS, Bild DE, Kurosaki TT. Prevalence of hypertrophic cardiomyopathy in a general population of young adults: echocardiographic analysis of 4111 subjects in the CARDIA Study--Coronary Artery Risk Development in (Young) Adults. Circulation. 1995;92:785-789.
- Corrado D, Basso C, Pavei A, Michieli P, Schiavon M, Thiene G. Trends in sudden cardiovascular death in young competitive athletes after implementation of a preparticipation screening program. JAMA. 2006 Oct 4;296(13):1593-601
- Jonathan A. Drezner, MD, Jordan S.D.Y. Chun, MD, Kimberly G. Harmon, MD, Linette Derminer; Survival trends in the United States following exercise-related sudden cardiac arrest in the youth: 2000–2006 (Heart Rhythm 2008;5:794 –799) © 2008 Heart Rhythm Society. All rights reserved.
- Antonio Pelliccia, Fernando M. Di Paolo, Domenico Corrado, Cosimo Buccolieri, Filippo M. Quattrini, Cataldo Pisicchio, Antonio Spataro, Alessandro Biffi, Maristella Granata, and Barry J. Maron, Evidence for efficacy of the Italian national pre-participation screening program for identification of hypertrophic cardiomyopathy in competitive athletes. European Heart Journal 2006 doi:10.1093/eurheartj/ehl137
- DeBauche T "Cost effective complete screening of athletes in a large district" American Heart Association 2009: Abstract 865.
- Robert J. Myerburg, MD; Victoria L. Vetter, MD Electrocardiograms Should Be Included in Preparticipation Screening of Athletes; Circulation. 2007;116:2616-2626.)© 2007 American Heart Association, Inc.
- Aaron L. Baggish; Should Electrocardiography Be Used in Cardiovascular Screening of High School Athletes? Ann Intern Med July 6, 2010 153:64-65;
- Matthew T. Wheeler, Paul A. Heidenreich, Victor F. Froelicher, Mark A. Hlatky, and Euan A. Ashley; Cardiovascular Screening in College Athletes With and Without Electrocardiography: A Cross-sectional Study; Ann Intern Med March 2, 2010 152:276-286;