Screening college athletes with ECGs remains a hot topic

As chief medical officer of the National Collegiate Athletic Association (NCAA), Brian Hainline, MD, oversees a diverse group of more than 1,100 schools. The colleges are located across the U.S. and have various levels of access to physicians, hospitals and medical centers.

With that in mind, the NCAA convened a multidisciplinary task force in 2014 to examine cardiovascular care in college athletes with a particular emphasis on sudden cardiac death and the utility of screening with an electrocardiogram (ECG). The resulting document, published earlier this year in the Journal of the American College of Cardiology, provided a consensus statement from the NCAA, American College of Cardiology (ACC), American Heart Association (AHA) and other cardiac and sports medicine organizations on cardiovascular care for college student athletes.

Based on their discussions and research, though, the committee could not recommend that all athletes undergo screening with an ECG.

“I think an [ECG] in a highly resourced center that has expertise on-site, there’s no question that it’s useful and it adds knowledge,” Hainline told Cardiovascular Business in a telephone interview. “But an electrocardiogram when you don’t have that knowledge base and you don’t have the resources, that’s when it gets tricky because if there’s not a proper interpretation and if you’re doing more tests than are needed or if you disqualify someone who shouldn’t be disqualified, then that’s an adverse outcome. Our goal is to move everyone to the capability of having high resources, either on-site or through one of the regional referral centers.”

Whether or not to screen with ECGs has been a source of debate for years. Although the NCAA requires athletes to undergo medical evaluations, the organization does not have specific criteria for the examinations. Thus, schools can choose to screen with ECGs or decide it’s not worth it.

Hainline said that ECGs are effective at detecting hypertrophic cardiomyopathy and rhythm disturbances, which are common causes of sudden cardiac death. However, they cannot detect two other leading causes of sudden cardiac death: anomalous aortic origin of a coronary artery and aortic root dilation.

If schools decide to screen with ECGs, Hainline suggested they provide athletes with information on their rationale and provide the potential risks and benefits of ECGs. He also mentioned the colleges should use modern ECG equipment, interpret ECGs using updated standards and employ people who are trained according to ACC/AHA/Heart Rhythm Society recommendations.

“I think the document demonstrated that there’s enough agreement that we can’t recommend [ECG] screening across all NCAA member schools because there’s not the infrastructure or knowledge base to support that,” Hainline said. “On the other hand, for those that are sort of naysayers for screening, for those centers that really do it exceptionally well, they really can provide guidance for how screening can be done. There’s sort of a meeting of the minds that’s evolving. That really was, to me, one of the most important things that this paper could provide to the medical community.”