HeartRhythm: Cost-effective ECG screening for athletes may be feasible

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Implementing a widespread, cost-effective electrocardiographic screening program for young athletes could be feasible and potentially could help reduce the rate of sudden cardiac death, according to a study published in the October issue of Heart Rhythm.

“Sudden cardiac death (SCD) in young adults (less than 35 years) is an emotionally staggering event, not only for the victim’s family but also for the community,” Joseph Marek, MD, of the Midwest Heart Foundation in Oakbrook Terrace, Ill., and colleagues wrote. “It likely is responsible for more than 2,500 deaths per year in the United States. Although the precise incidence in the United States is not known, it ranges between 0.6 and 13 deaths per 100,000.”

To understand what the feasibility would be of integrating large-scale electrocardiographic (ECG) screening of young athletes in the U.S., Marek and colleagues performed the Young Hearts for Life (YH4L) study, which enrolled 32,561 high school-age students who underwent ECG screening between September 2006 and May 2009.

Patients had a mean age of 16 and 30 percent participated in organized sports.

Of the 32,561 patients screened, 2.5 percent had abnormal ECGs that required further evaluation. The majority of these abnormal screens occurred in males, and only 0.81 percent were determined to be technically inadequate.

“The study demonstrates the feasibility, high quality and large-scale application of ECG screening for young adults in the United States,” the authors wrote. Additionally, the study showed that mass ECG screening at a low cost is feasible.

During the study, the average cost per ECG was $8.67 when the YH4L model was used. In the current study, physician ECG interpretation was on a volunteer basis; however, the Centers for Medicare & Medicaid Services reimbursement for the physician component of ECG interpretation was $9.52 (2009 data). One program estimated that paying physicians to read imaging exams at an hourly rate would cost $4.50 per ECG, which was deemed a small price tag considering the potential implications.

“SCD in young adults is of great concern to the community,” the authors wrote. “There is considerable disagreement on the proper strategy to identify healthy youth at risk for SCD.” For example, some have argued that the rate of abnormal ECGs would be unmanageably high, with one study reporting a frequency of 40 percent.

“It is feared that this could drain the resources of the medical community and not meet reasonable cost-effectiveness criteria demanded of a screening program," Marek and colleagues wrote. "This one concern has been a major deterrent to the adoption of widespread ECG screening.”

Recently, the American College of Cardiology (ACC) estimated that the combined disease prevalence of all cardiovascular disorders that predispose young athletes to SCD was 0.3 percent. “It is likely that follow-up evaluations for individuals in this study with a positive screen would yield a similar proportion of identified cardiovascular disease," they wrote.

“Our findings have important implications for the implementation of ECG screening and the potential to reduce the rate of SCD in U.S. youth,” the authors wrote.

“The screening process is an important step in trying to save lives because it helps us identify the individuals who are at the greatest risk of SCA [sudden cardiac arrest] and, ultimately, it has the potential to prevent incidents of sudden death from occurring,” Marek said in a statement. “As proof, some European countries have implemented successful screening programs in high volume that show great success in reducing SCA in young adults.”