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Sudden deaths of young athletes fuel the heart screening debate

by Olga Deshchenko, DOTmed News Reporter | June 28, 2011
From the June 2011 issue of HealthCare Business News magazine

According to Marek, as embarrassing as it is for the medical community to admit, few physicians actually know how to calculate a false positive rate and no specific data on the false positive rate of ECGs is currently available.

Some previous research has concluded ECGs produce an abnormal rate of 10 to 40 percent. But that’s because the abnormal rate included “a lot of findings that are normal variance in these young adult athletes and clearly are not indications of the disease we’re looking for,” says Marek.

“When you narrow the criteria to just the conditions that we’re looking for, you get a very acceptable abnormal rate,” he says. “It’s not something that’s going to overwhelm the community with extensive testing.”

Marek also says screening programs for diseases such as breast and prostate cancer have much higher false positive rates – why hold this screening to a different standard?

In a study of 32,000 students screened through the YH4L program, Marek says his team found the abnormal rate of ECGs to be in the low single digits. (The results will be published in September.)

“Just because there is no data that clearly shows it is beneficial, doesn’t mean it shouldn’t be done,” he says. “We do hundreds of things in medicine where there is no definitive data.”

Another benefit of comprehensive screening is that it may catch health issues unrelated to sudden death risk conditions.

At Beaumont Hospital, the screening program identified many students with beginnings of hypertension. “I’d say probably somewhere around 10 percent of our kids were allowed to continue in sports but were recommended to follow up with their own physicians,” says Berman. “I think the earlier you light people up to that sort of problem, the better off they’re going to be.”

For many, it becomes harder to argue the value ECGs based on cost -- is there a price too high when a child’s life hangs in the balance?

ECG proponents say the cost of the tests is miniscule compared to the country’s significant health care spending and innovative approaches can help lower the price tag.

“I believe there are ways we could make this work and I believe it’s our responsibility to do that,” says Snyder, who lost a 17-year-old daughter to sudden cardiac arrest. “While we’re debating whether we can afford this, kids are dying. And we don’t know how many.”

A screening community model
Advocates of broad cardiac screening using ECGs often cite community programs as solutions to keeping the cost to a minimum while still screening a large percentage of active youths.

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