Thursday, May 3, 2012

Testing Young Athletes for Heart Disease

Sudden death from heart disease is rare in young persons. However, the risk of sudden death is almost three times greater among athletes in high-risk sports such as basketball, football, and soccer, just because of the very physical nature of these sports. Approximately 90 young competitive athletes die suddenly each year from undiagnosed underlying heart disease. Is this enough deaths to warrant mandatory screening of all young athletes for underlying heart disease?

Sudden death from cardiac disease in young persons usually is due to either a problem with the electrical activity of the heart or to a condition called hypertrophic cardiomyopathy, a long way of saying that the heart muscle is abnormally thickened. Both conditions could be detected by an ECG (electrocardiogram). But an ECG is fairly expensive – more than $1,000 without insurance – which might prohibit some young athletes from participating in sports if it were required.

The American Heart Association does not yet recommend mandatory screening of all young athletes for heart disease, in part because of the high cost versus the small number of people who would benefit. However, a fairly recent paper in the Annals of Internal Medicine indicates that screening for heart disease might actually be cost-effective. The study’s authors estimate the long-term costs to society of treatment of cardiac disease in athletes found to test positive, as well as estimates of how many life years would be saved. The study finds that ECG screening would save an additional two life years for every 1,000 athletes tested, at a net cost of under $90 per athlete, compared to the current standard of just a history and physical.

Ultimately, someone will have to decide whether ECG testing of student athletes would be worth it. For now, it’s not required.

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