Pre-Screening For Cardiac Risks In Young Athletes Found To Be Flawed

An analytical review on the pros and cons of the screening for cardiac risks in young non-professional athletes (ranging between 14-34 years) to avoid sudden cardiac death was published in the BMJ, on 20th April, 2016. The analysis was performed keeping cardiac trends of Italy, US and UK under consideration. The findings suggested that there are more negative impacts than benefits of the pre-screenings as false positive diagnosis can affect career of the athlete, in addition to halting the chances of physical exercise due to incorrect diagnosis. The potential of sudden death reduction was found to be low due to poor detection rate and the uncertain effectiveness of the management of the diseases in healthy individuals.

The analysis was performed on young athletes participating in an organized team or individual sport that involved regular competition against others, and required some form of systematic training, either in school or college.

Some major facts regarding government laws and actions were also stated in the analysis by researchers. It was noted that Italy was the only country promoting the act of pre-screening on national level for young athletes since 1970s. However, in Netherlands (1984) and UK (2015), the screening tests were abandoned due to substandard screening procedures.

Analysis identified ‘hypertrophic cardiomyopathy’ to be the major underlying reason for sudden deaths. However, prevalence rate was found to be low i.e., 0.5 to 1 per million individuals in UK. The high risk of sudden death due to cardiac disorders was found to be more in men than women. According to the stats by the UK National Screening Committee, an annual incidence of 1 death per 100,000 people aged 12-35 was reported. The exact figures for the sudden cardiac death events varied in heterogeneous populations and school and college records involving young athletes reporting varying incidences between 1 per 917,000 to 1 per 3,000 deaths. A UK based study including athletes of 12-35 years of age reported 64 deaths a year.

Literature review found out that the major screening procedure recommended by the American Heart Association entails taking a personal and family history along with a physical examination. In order to improve the efficacy of the screening procedures and for better prediction of certain arrhythmias, inclusion of electrocardiogram (ECG) was suggested by the findings of the analysis, especially for the individuals suffering from the Wolff-Parkinson-White syndrome. It was also highlighted after the analytical review that the detection of cardiac risk factors in the individuals suffering from coronary arteries cannot be done by the electrocardiography, leaving 25% of affected people undiagnosed, concluding the sensitivity of the electrocardiography to be 0.75 only.

Sub-standardized diagnosis was also found to be the number one factor for doubting the efficacy of the pre-screening procedures in young individuals, and chances of labeling healthy people as (false positives) carriers of heart complications were also highlighted. On the contrary, it was also studied that sometimes due to inappropriate diagnostic screening technique e.g., using resting ECG for a patient with abnormal cardiac symptoms, might show normal results, thus leaving affected individual undiagnosed. So, the hassle of conducting pre-screening techniques was found to be futile.

Lack of scientific evidence for characterizing pre-screening procedures effective for diagnosing abnormal cardiac activity of athletes leaves many loopholes and abstains from reaching to a definitive conclusion. However, the positive picture of the screening procedures leading to saving lives was painted by an Italy based study. Study affirmed a 90% reduction in the incidence of sudden cardiac death in young athletes aged 26, in the Veneto region. These findings, however, are considered controversial due to the exclusion of the other important factors involved in improving life expectancy, by the Italian scientists.

While discussing the harmful impacts of the pre-screening strategies, researchers stated that unnecessary screening procedures can result into increased chances of additional cardiovascular testing, which causes anxiety and psychological harm, unnecessary restrictions and disqualifications from sports, as 2%, or 20,000 of the one million people screened, were ultimately disqualified from participating in competitive sports, according to the Veneto based Italian study. However, the BMJ review opposed this act by stating: “As long as those at high risk of sudden death cannot reliably be identified and appropriately managed, young athletes should not be submitted to pre-participation screening.”

According to American Heart Association, hypertrophic cardiomyopathy — a condition occurring due to enlarged heart muscle cells, leading to blocking the blood flow out of the ventricles — is considered as the leading cause of the sudden cardiac arrests in young athletes. It raises blood pressure and disrupts normal functioning of heart due to cardiac arrhythmias (abnormal heartbeats).

Wolff-Parkinson-White syndrome is a condition characterized by extra electrical signaling of the heart that can lead to periods of fast heart rate (tachycardia), according to US National Library of Medicine.

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