Mandantory ECGs for Athletes Is a Debateable Issue According to Scientific Tests
With all the media hysteria surrounding the recent deaths of two high school athletes due to cardiac arrest, and because we are all concerned about our children’s health, we have collected data that indicates an athlete having a cardiac arrest is an unusual anomaly.
Many people now believe every athlete should be screened with a mandatory ECG. Our Google search indicates this is a debateable issue, even in the scientific community.
The heart trace — also known as an ECG — has been required in Italy, the only country where it is required by law, for 30 years.
Dr. Antonio Pelliccia of the Institute of Sports Medicine and Science in Rome and Dr. Domenico Corrado Antonio Pelliccia of the University of Padua Medical School in Padua, Italy, found the incidence of sudden deaths fell by 89 percent after implementation of the program and no deaths were reported among athletes disqualified from competition because of hypertrophic cardiomyopathy.
However, Dr. Roald Bahr of the Oslo Sports Trauma Research Center at the Norwegian School of Sport Sciences in Oslo, Norway, says the diagnostic accuracy of ECG screening varies and false positives can be as high as 40 percent. He notes the conditions that cause cardiac death differ substantially between populations.
In other words, a screening program that successfully identified cardiomyopathies in Italy may not be effective in Norway where this seems to be a rare cause of death.
“Screening of hundreds of thousands of athletes to save possibly one life a year, cannot be justified,” Bahr said in a statement.
In another study, according to an article in The Grand Rapids Press. a law requiring athletes in Israel to undergo electrocardiograms before participating in sports did not lower their risk for cardiac arrest, according to a study reported today in the Journal of the American College of Cardiology.
The report comes at a time when the debate over cardiac screening for athletes is highlighted by the death of Wes Leonard,a 16-year-old Fennville basketball star who died of sudden cardiac arrest Thursday following an intense game.Sudden cardiac death occurs in an estimated 1 in every 200,000 U.S. athletes. The American College of Cardiology does not support mandatory ECGs for all young athletes.
In the report published today, a team of researchers based in Tel Aviv analyzed the effect of routine cardiac testing in the article, Mandatory Electrocardiographic Screening of Athletes to Reduce Their Risk for Sudden Death: Proven Fact or Wishful Thinking?
In 1997, the National Sport Law enacted in Israel mandated the screening of all athletes with resting and exercise ECG testing. The researchers searched the two main newspapers in Israel and found reports of 24 sudden cardiac arrests among competitive athletes from 1985 to 2009. Of those, 11 occurred before the 1997 legislation, and 13 occurred after it.
The study, which took into account changes in population over time, concluded that mandatory screening had no apparent effect on the risk of cardiac arrest.
The findings are in stark contrast to a 2006 report in the Journal of the American Medical Association, which found that ECG tests in Italy reduced sudden cardiac deaths by 89 percent.
The Israeli researchers question whether the screening is worth the cost. The Italian model costs $40 per athlete and, assuming the data on the number of lives saved is correct, 33,000 athletes must be screened to save one life, the study says. That would make the cost per life saved to be $1.32 million, not counting the advanced testing which would be needed.