Oct 28, 2016
Better Heart Screens?

Heart screenings for athletes have the potential to be more accurate and cost-effective, according to a recent study conducted by cardiologists from the University of British Columbia-Vancouver Coastal Health in Vancouver, British Columbia. Their findings were published in the Canadian Journal of Cardiology and outline new protocols for conducting heart screenings.

The researchers compared their own screening methods to what is recommended by the American Heart Association (AHA). Both protocols involve using questionnaires and 12-lead electrocardiograms (ECGs) to help determine whether a patient has a heart condition. The AHA screening also includes a physical exam involving auscultation—listening to the heart. 

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One of the major criticisms of the AHA questionnaire is that it frequently produces false positives. When this occurs, a series of additional tests with a cardiologist is required, which can be costly and cause anxiety in the patient. In order to reduce the number of false positives, the researchers used an evidence-based questionnaire that was designed to better determine whether symptoms indicated cardiac disease or other benign conditions. This proved to be more accurate at determining serious heart conditions than the AHA questionnaire.

A total of 1,400 young competitive athletes ages 12 to 35 were screened for the study. Approximately half received the AHA screening, and the other half underwent the experimental protocol.

Overall, the false-positive rate of the experimental protocol was less than half that of the AHA protocol (3.7 percent vs. 8.1 percent). In total, seven athletes were found to have serious heart conditions, with six being identified by ECG. It was determined that relying solely on a patient’s medical history and a physical exam would have caught only two of those seven cases.

 From these results, the researchers concluded that the ECG is the most effective method for identifying cardiac conditions:

“The current study provides further evidence to support the use of the ECG as an important tool in the screening of young competitive athletes,” explained lead investigator James McKinney, MD, MSc, of the Division of Cardiology of the University of British Columbia. “The ECG is more sensitive in detecting heart muscle problems and potentially life-threatening electrical disorders such as Wolff-Parkinson-White and long QT syndrome.”

Physical exams and auscultation both proved to be significantly less accurate than an ECG. In fact, these methods indicated 10 athletes required follow-up evaluations with a cardiologist, who didn’t find heart conditions in any of them. One of the reasons why auscultation was not as effective as some of the other tools is that it’s difficult to do with complete certainty. 

“Cardiac auscultation requires years of experience, and conditions during mass screening are not ideal for meticulous cardiac auscultation,” Michael Papadakis, MBBS, MD, and Sanjay Sharma, MBChB, MD, of St. George’s University of London, wrote in a related editorial.

By concluding that physical examinations are much less effective at identifying heart conditions than previously thought, the researchers suggest screening athletes on a large scale could be made much less expensive. Eliminating the need for an on-site physician would result in huge reductions in per person screening costs ($14.42 for experimental protocol vs. $97.50 for AHA protocol) and costs per diagnosis ($3,822.70 vs. $41,320.49, respectively).

These findings will continue to shake up the conversation around the controversial topic of heart screenings. By optimizing new protocols that make the process more reliable and less costly, screenings may continue to become increasingly accessible for competitive athletes, which could potentially save lives.

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