Cardiac Screening Before Participation In Sports
The death of a high school athlete is a highly emotional event. Apart from the devastation within a family unit, the sudden nature of the event and the loss of decades of life have a lasting impact on friends, peers, and both the lay and medical communities. Deaths are usually attributable to hereditary or congenital abnormalities affecting the cardiac structure or the electrical system of the heart. These conditions are often associated with a relatively quiescent natural history and favorable prognosis in most sedentary persons but with an increase in the risk of sudden cardiac death among athletic youth that is two to five times greater than the risk in more sedentary youth.
Approximately 100 young athletes die from sudden cardiac arrests in the United States every year. According to analysis of a series of 1866 deaths in young athletes, 65% of young athletes who die from sudden cardiac arrests are of high-school age. (1) Most of these young adults lose at least 50 years of normal life expectancy, representing a minimum of 5000 life-years lost annually; therefore, sudden cardiac death in young athletes may be considered to be an important public health issue. Although the incidence of sudden cardiac death among athletes is approximately 1 death in 50,000 athletes, it is well recognized that 1 in 300 young persons harbors a cardiac condition that can result in instantaneous death. The unpredictability of such catastrophes and their occurrence without previous warning symptoms are a strong and obligatory incentive in any compassionate society to support cardiac screening of all high school athletes. The obligation is magnified by the fact that most implicated diseases can be diagnosed during life and by the fact that there are several therapeutic strategies to minimize the risk of death.
Indeed, both the American Heart Association (AHA) (2) and the European Society of Cardiology (ESC) (3) advocate preparticipation cardiac screening of young athletes. It is ironic that screening is performed in college athletes and in more than 90% of professional athletes in the United States, yet these athletes are less likely to have serious forms of primary cardiomyopathies, since rigorous training schedules in middle school and high school eliminate those with impaired myocardial function. Therefore, any reluctance to screen the most vulnerable cohort of athletes — those in high school — seems deplorable. The detection and proper management of a potentially life-threatening genetic or congenital cardiac disorder in such persons is associated with disproportionately better outcomes than those in persons with ischemic heart disease or heart failure — and at a much lower cost. Furthermore, evaluation of the family members of an athlete who has received a diagnosis of a genetic disorder provides an invaluable opportunity to identify other young relatives at risk. The early identification of a young person at risk also permits informed decisions relating to exercise and the pursuit of appropriate career paths.
There is no evidence that preparticipation cardiac screening deters young athletes from participating in competitive sports. On the contrary, promoting safe exercise is likely to achieve the most important goal of Western health care organizations: a reduction in cardiovascular disease burden. Cardiac screening of young, impressionable persons also has the potential to raise awareness of cardiac disease and to promote healthier life habits in the future. The postulated financial burden for some families is worthy of mention, but most parents already invest large sums on sports club membership, coaching, and sports equipment to help their children realize their ambitions; in contrast, the fee for minimizing the risk of an exercise-related sudden cardiac death in their child is very small. In summary, preparticipation cardiac screening should be required for all young athletes before they engage in organized competitive sports.
Story Credit: http://www.nejm.org/doi/full/10.1056/NEJMclde1311642?page=1#t=cldeOpt1
