NCAA’s chief medical officer discusses cardiovascular care for student athletes

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For the past three decades, five to 10 student athletes competing for National Collegiate Athletic Association (NCAA) schools have died each year due to sudden cardiac death. Many more college athletes suffer from cardiovascular-related issues, as well.

With that in mind, the NCAA convened a multidisciplinary task force that met in September 2014 to discuss cardiovascular concerns and how to better care for student athletes. After that two-day meeting, the group continued to develop ideas and focus on important areas, including sudden cardiac death and screening with or without electrocardiograms.

Earlier this year, the NCAA, American College of Cardiology (ACC) and other leading cardiac and sports medicine organizations released an interassociation consensus statement on cardiovascular care for college student athletes.

Lead researcher Brian Hainline, MD, the NCAA’s chief medical officer, and colleagues published their findings in the Journal of the American College of Cardiology. Hainline also sent a memorandum to all of the head athletic trainers and team physicians for NCAA member schools outlining the best practices for cardiovascular care of student athletes.

“What this document does, although it’s not legislation, because it’s endorsed by so many organizations, it really creates a new cultural norm for the schools,” Hainline told Cardiovascular Business in a telephone interview. “Our plan with this is to provide this as a pretty strong recommendation. It’s not legislated. It’s not mandated. But because it is an interassociation document, what we’ve been finding is that the schools will follow it. To legislate something like this would take two or three years. It’s just an onerous and bureaucratic process that doesn’t work as smoothly.”

Hainline and his colleagues defined sudden cardiac death as “an unexpected death due to cardiac causes that occurs in a short time period in a person with or without previously known cardiovascular disease.” They found that the overall risk of sudden cardiac death in an NCAA student athlete was 1 in 54,000 athletes per year, including 1 in 38,000 for male athletes and 1 in 122,000 for female athletes. Further, the risk of sudden cardiac death is more than three times higher in African-Americans (1 in 22,000) than in Caucasians (1 in 68,000).

Some sports have higher risks of sudden cardiac death. For instance, men’s basketball and football players represent 23 percent of all male NCAA athletes, but they account for half of all sudden cardiac death cases. Still, Hainline said that it is difficult to accurately determine the rate of sudden cardiac death in subgroups because there are so few deaths each year.

The NCAA requires each student athlete to undergo an evaluation from a licensed medical doctor or doctor of osteopathic medicine within six months of participating in the sport. They also must complete a health history questionnaire and have their blood pressure measured each year. However, the NCAA has no established criteria for the pre-participation evaluations and does not require that the team’s physician conduct the medical examination.

In this document, Hainline and his colleagues suggest that schools follow the American Heart Association (AHA) recommendations to ask student athletes about their personal and family cardiovascular history and conduct a physical examination, including testing for a heart murmur, femoral pulses, physical stigmata of Marfan syndrome and brachial artery blood pressure.

Still, although pre-participation screening has been conducted for more than 50 years, the researchers mentioned that there is not much evidence showing that screening prevents sports-related deaths in athletes. They added that the broad nature of the questions lead to a high number of positive responses that may not indicate risk for athletes.

“The AHA recommends review of positive questionnaire responses by physicians to determine if further evaluation is warranted,” the researchers wrote. “However, the ability of practitioners to discern true positive from false positive responses has also never been studied prospectively in a large-scale clinical trial.”

Hainline added that no adequately designed study has shown that using a resting 12-lead electrocardiogram as a screening tool helps prevent sudden cardiac death in athletes. In fact, 60 percent to 80 percent of athletes who have sudden cardiac death do not have warning signs or symptoms before the event. Further, an