Screening athletes for hidden heart problems may not help prevent sudden deaths, a new study from Israel finds.
Mandatory screening has been in place in Italy and Israel for years, while in the US there has been some debate over whether to launch similar policies.
Sudden cardiac deaths in athletes are rare. A recent study estimated that between 2000 and 2006, an average of 66 athletes younger than 40 died each year from cardiac arrest.
But because those deaths are so tragic, some advocates have argued that electrocardiographic (ECG) screening should be required for high school and college athletes.
ECG screening has been mandatory in Italy since the early 1980s. In 2005, the European Heart Society recommended it become mandatory in all European countries, based on an Italian study showing a sharp reduction in sudden deaths among athletes since its national law took effect.
Israel, meanwhile, has had mandatory ECG screening since 1997 not only for competitive athletes, but for anyone who wants to join an "organised" sports activity - which includes joining a gym.
But the new Israeli study, published in the Journal of the American College of Cardiology, cast doubts on the usefulness of mandatory screening.
Reports of cardiac deaths in athletes
Using newspaper reports, the authors found a total of 24 documented cardiac-arrest deaths among competitive athletes between the ages of 12 and 44 - 11 deaths before the law was enacted in 1997, and 13 after it.
The annual mortality rate per 100,000 athletes was about 2.5 before the law and about 2.6 afterward, the researchers estimate.
"The results are not at all surprising," said senior researcher Dr Sami Viskin, a cardiologist at Tel Aviv Medical Centre.
The lack of benefits
Sudden deaths among athletes are so uncommon - and ECGs imperfect enough - that the lack of benefit is to be expected, he said.
That sentiment was echoed by Dr Barry J. Maron, of the Minneapolis Heart Institute Foundation in Minnesota, who was not involved in the study.
"Sudden death in athletes is a rare phenomenon," he said in an interview. "Each one is tragic, but if you try to demonstrate that an intervention is effective (at prevention), it's going to be difficult."
But even if screening were to prevent just a few deaths, why not do it?
Routine ECG screening
Dr Maron said that routine ECG screening "sounds good," but mandatory screening on a national level - especially in a country as big as the US - is not really feasible.
Perhaps the biggest problem, he said, is that roughly 20% of screening ECGs would be positive - and most of those would be false-positive.
Dr Maron also said a national policy of screening young athletes would be "discriminatory." The rate of sudden death among non-athletes is actually higher, so limiting screening only athletes would be exclusionary, he said.
He's not against screening by individual organisations, however.
Last year, Harvard University found that ECG screening of student athletes picked up more cases of heart problems than physical exam and family history.
"If Harvard wants to screen their athletes, that's different" than a mandatory national programme, Dr Maron said.
As for the Italian study that found a sharp drop in sudden deaths among athletes with mandatory screening (from 3.6 to 0.4 per 100,000), both Dr Viskin and Dr Maron pointed out that the Italian study included data from only the two years before the law was implemented. The current study, by contrast, looked at the decade preceding Israel's law.
Dr Viskin doubts his findings will have any effect on Israel's law. "There is no going back," he said. "There is too much 'wishful thinking.'"
But he said the findings should inform debates in the US and other countries that do not currently have mandatory ECG screening. (Reuters Health/ March 2011)
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