Screening young athletes for heart abnormalities with an electrocardiogram test may be a cost-effective way to identify at-risk youth and save lives, according to a new study.
But the findings may also add fuel to what has become an often emotional debate.
Researchers from the Stanford University School of Medicine examined sudden cardiac deaths among U.S. high school and college athletes aged 14 to 22 and conducted a calculation to see what influence various types of screenings would have.
They found that adding an ECG to two common screens already in place -- a physical and taking a health history of each athlete focusing on cardiovascular fitness -- could be expected to save about two years of life per 1,000 athletes at a cost of $89 per athlete. (Analyses of this type commonly refer to years of life saved instead of referring to individual lives.)
The total cost of adding the ECG screening test would be $42,900 per year of life saved, the authors found -- a sum that is in line with other healthcare expenditures that society undertakes, such as the cost of dialysis for patients with chronic kidney disease ($20,000-$80,000 per year of life saved) or public access to defibrillators ($55,000-$162,000).
The finding, released Monday and published in the Annals of Internal Medicine, was based on a similar 2006 analysis that found that a mandatory, nationwide pre-participation screening program for young athletes in Italy lowered the incidence of sudden cardiac death by 89% over 25 years. The authors concluded that adding ECG tests to ones already in place for young athletes was not prohibitive and should be considered.
"This information should not be a prescription -- we're not telling people what to do," said study lead author Dr. Matthew Wheeler, a fellow in cardiovascular medicine at Stanford University School of Medicine.
Wheeler also acknowledged that the number of young athletes who die from sudden cardiac death is still under dispute. His study used a death rate of two athletes per 100,000 athletes per year, as reported in a 2008 study, to determine costs and benefits. But if the number of deaths is, in fact, lower, the cost of ECG screens would be higher.
High school and college athletes are usually screened for cardiovascular abnormalities with just a physical and health history, although some high schools and colleges also employ ECG tests. The highly publicized and poignant incidents of young athletes dying on the field because of undetected heart abnormalities has led to a call from some healthcare providers, athletes and parents for routine ECG screenings.
The test could identify conditions such as hypertrophic cardiomyopathy, a thickening of the heart muscle that makes it work harder to pump blood, a common cause of sudden death among young athletes.
But routine ECG screens may be impractical, said Dr. Barry Maron, director of the Hypertrophic Cardiomyopathy Center at the Minneapolis Heart Institute Foundation, who wrote an editorial accompanying the report.
Complications include the sheer number of tests that would be needed; the fact that tests would exclude non-athletes who may also have genetic cardiovascular conditions; and that disqualifying an athlete because of a pre-existing heart condition could lead to lawsuits, he said.
In addition, ECG readings are estimated to have a 7% to 20% rate of false positives, which could lead to further invasive testing that may not be warranted.
"My bottom line is that the screening issue is much more complex than at first glance," Maron said.
Identification of abnormalities -- even if they are not life-threatening -- may also hamper the ability of young athletes to later get health insurance, said Dr. Paul D. Thompson, director of cardiology at the Athlete's Heart Program at Hartford Hospital in Hartford, Conn.
There could be better ways to ramp up safety, he said, adding, "Is training more people in CPR better, or having more defibrillators available?"
Wheeler said the best next step would be to make incremental changes in offering ECG screenings, starting at the high school and college level.
"This is a hugely important study," said Dr. Jonathan Drezner, an associate professor of family medicine at the University of Washington in Seattle who has studied sudden cardiac death among athletes. "I think the results need to be considered, to see what is the appropriate protocol in the U.S."