Circ: NCAA needs a more intensive screening process to prevent SCD

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An estimated one in 44,000 National Collegiate Athletic Association (NCAA) athletes experiences sudden cardiac death (SCD) per year, leaving clinicians wondering whether a more extensive screening process may be necessary, according to a study published online April 4 in Circulation.

Kimberly Harmon, MD, of the University of Washington in Seattle and colleagues used insurance claims and NCAA data to track deaths that occurred between 2004 and 2008 to better understand whether screening guidelines for these athletes should be overhauled to include more extensive screening methods.

While almost 400,000 students ages 17 to 23 participate in NCAA sports per year, Harmon et al found that between 2004 and 2008, 273 deaths from all causes occurred. Of the 80 athletes who experienced medical causes, 56 percent were cardiovascular-related sudden deaths.

The researchers reported that of the 36 deaths that occurred during or after exertion, 27 were related to cardiac causes. The study showed that one in 43,770 athletes died of SCD per year. Of the other 273 deaths, 187 athletes died from non-medical/traumatic causes and the other 2 percent died from unknown causes.

Harmon et al also reported that African-Americans experienced SCD at a higher frequency than their white counterparts, one in 17,696 vs. one in 58,653, respectively.

Basketball players saw the highest rate of SCD (one in 11,394) and swimmers had the second-highest risk, followed by lacrosse, football and cross-country track. For Division I male basketball athletes, the risk of SCD was one in 3,000.

“You have to revisit the whole question of whether a more extensive screening makes sense in light of these new numbers,” wrote Harmon. “The question is: where do you set the risk cutoff — one in 10,000, or 40,000, or 100,000?”

The researchers said the heightened incidence rates within this student athletic population could help determine whether the process of screening these athletes should include an electrocardiogram or echocardiogram.

Previously the European Society of Cardiology and the International Olympic Committee had suggested that ECGs be added to the screening process for athletes, but the American Heart Association panel deemed this move too costly for the large U.S. athletic population.

However, Ralph L. Sacco, MD, president of the AHA said, “The American Heart Association regards cardiovascular screening for athletes as an important public health issue, for which there are compelling ethical, legal and medical grounds.”

In addition, he offered, “We strongly encourage student-athletes and other participants in organized competitive sports to be screened with a careful history, including family history, and thorough physical examination. The American Heart Association also believes healthcare professionals providing the screening should be able to order noninvasive testing when they judge it is needed.”

The authors concluded that more extensive screening should target high-risk groups, such as basketball players and offered that the placement of automated external defibrillators is necessary and should be placed in venues where high-risk sports are played.