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MEDICAL: TESTS AND TESTING :
HEALTH :
SPORTS: ATHLETES :
SPORTS MEDICINE: 
Study Shows Tests Could Identify At-Risk Youth Athletes



Study Shows Tests Could Identify At-Risk Youth Athletes
Researchers find that electrocardiograms may be a cost-effective way to 
reduce sudden cardiac deaths in high school and college athletes.
By Jeannine Stein
March 2, 2010
Los Angeles Times
<http://www.latimes.com/news/science/ 
la-sci-athletes-heart2-2010mar02,0,6198438.story>



A shorter URL for the above link:



<http://tinyurl.com/yz9usbs>



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.





Screening May Save Athletes
By NICHOLAS BAKALAR
Published: March 1, 2010
New York Times
<http://www.nytimes.com/2010/03/02/health/02heart.html>


They are young, strong, competitive athletes, in top physical condition. 
Yet about 90 of them drop dead every year, often in the heat of 
competition, victims of sudden cardiac death. Now a new study suggests 
that there is a cost-effective way to lower the death rate significantly: 
screening athletes with an electrocardiogram.

But starting such a screening program in the United States is 
controversial.

An earlier observational study, published in The Journal of the American 
Medical Association in 2006, confirmed the value of EKG screening. For 
almost 30 years, the Italian Ministry of Health has required screening for 
competitive athletes and tracked the results. Using those data, the study 
found that screening reduced the number of cardiac deaths by 89 percent 
among athletes 14 to 35 years old, making the rate similar to that among 
nonathletes of the same age.

The success of the Italian approach has led the European Society of 
Cardiology and the International Olympic Committee to recommend EKG 
screening for all competitive athletes. But the American Heart Association 
suggests only a medical history and physical exam.





JAMA. 2006 Oct 4;296(13):1593-601.

Trends in sudden cardiovascular death in young competitive athletes after 
implementation of a preparticipation screening program.
Corrado D, Basso C, Pavei A, Michieli P, Schiavon M, Thiene G.

Department of Cardiac, Thoracic, and Vascular Sciences, University of 
Padua Medical School, Padua, Italy.

Comment in:

J Pediatr. 2007 Mar;150(3):319-20.
Nat Clin Pract Cardiovasc Med. 2007 May;4(5):240-1.
JAMA. 2006 Oct 4;296(13):1648-50.

<http://www.ncbi.nlm.nih.gov/pubmed/17018804>




Study: EKGs for young athletes cost-effective
Erin Allday, Chronicle Staff Writer
Tuesday, March 2, 2010
San Francisco Chronicle 
<http://www.sfgate.com/cgi-bin/article.cgi?f=
/c/a/2010/03/01/MNEK1C98P7.DTL#ixzz0h1pVeG1m>



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<http://tinyurl.com/yemvxyo>



Ethical questions
Regular screening raises some ethical questions. For example, some doctors 
argue that it might not be fair to test only athletes for heart problems, 
when all other students might benefit from screening. There's also the 
matter of letting athletes and their families decide for themselves what 
an acceptable risk is before automatically disqualifying them from sports.

Additionally, electrocardiograms frequently give false positive results, 
said Dr. Kishor Avasarala, a pediatric cardiologist at Children's Hospital 
Oakland. That means that some young people would be forced to get further 
testing - causing stress, adding expense and possibly delaying a student's 
athletic career.

That might seem a worthwhile exchange for saving lives, but for many 
students, delaying an athletic career could mean risking a college 
scholarship, or keeping a young person out of sports entirely.

"We can justify it with 'We're trying to save lives' and 'What is the cost 
of one life vs. missing one season of athletics?' " Avasarala said. "There 
are still questions about the real efficacy of screening."




Sports Death Risk in Harvard Athletes Seen With $88 Heart Scan
March 02, 2010, 12:03 AM EST
Business Week
By Tom Randall
Bloomberg
<http://www.businessweek.com/news/2010-03-02/
sports-death-risk-in-harvard-athletes-seen-with-88-heart-scan.html>



A shorter URL for the above link:



<http://tinyurl.com/yh479h6>



March 2 (Bloomberg) -- Screening for heart defects in high school and 
college athletes should be expanded after an $88 heart scan detected 
life-threatening conditions in Harvard University athletes, researchers 
said.

Tests known as electrocardiography, or ECG, identified two players who 
were deemed healthy in routine examinations despite having dangerous 
defects that should bar them from competition, according to a study 
published in the Annals of Internal Medicine. Scientists in three of the 
journals articles debated the merits of routine ECG tests for all 
competitive athletes.

Genetic heart defects caused the courtside deaths of Hank Gathers, an 
All-America 23-year-old basketball forward at Loyola Marymount University 
in Los Angeles, and Reggie Lewis, a 27- year-old All Star guard for the 
Boston Celtics of the National Basketball Association. Such defects are 
the top cause of sudden death in sports, killing 1 of every 220,000 young 
athletes each year, according to previous studies.

The most important thing in screening is that you dont miss people, said 
Aaron Baggish, a cardiologist at Massachusetts General Hospital in Boston 
and a clinical instructor at Harvard Medical School. Wed much rather 
screen a bunch of people and have to do more testing on a select few than 
miss one or two people and have them collapse.

The biggest drawback to the tests was the number of young athletes who 
were incorrectly identified as having a risk, Baggish said yesterday in a 
telephone interview. Thats because athletes undergoing intense training 
develop a natural stiffening of the heart wall that can be incorrectly 
diagnosed as a heart defect with an ECG, he said.




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