Apr 21, 2016
New PPE Guidelines On Heart Screens Issued

New guidelines for preparticipation physical exams (PPEs) for college athletes focus on identifying athletes at unreasonable risk of death or catastrophic injury from cardiac conditions, but they do not recommend large-scale use of electrocardiograms (ECGs). The guidelines come in a consensus statement published by the Journal of the American College of Cardiology and are supported by national sports and medical associations including the American College of Cardiology (ACC), the American Heart Association (AHA), the NATA, the NCAA, and the NSCA.

The ACC and AHA both recommend using the AHA’s 14-point questionnaire, which addresses family history, along with a physical examination. Although neither group recommends the widespread use of ECGs for cardiac screening, several colleges are routinely performing them on their athletes, and the task force did offer specific recommendations for such tests. These include that ECGs should only be conducted using equipment and personnel trained according to ACC/AHA/Heart Rhythm Society recommendations and that they must be interpreted using modern standards that distinguish normal findings for athletes in training from abnormalities that may suggest an underlying cardiac condition.

The guidelines also recommend that cardiology resources be available to interpret suspicious ECGs and guide secondary testing, but they also note that sports cardiology is a specialized segment of cardiovascular medicine with relatively few practitioners. The limited number of qualified physicians could be problematic for schools in smaller rural areas where these doctors are less likely to be found.

The task force recommends establishing regional referral centers that can provide pre-participation ECG interpretation, clarity on the cardiovascular status of athletes with irregular findings during their pre-participation screening, evaluations of new cardiovascular symptoms that develop during training or competition, and consultations on when a player with a cardiac issue is cleared to play.

In addition to guidance on PPEs, the task force also recommends that all school have a written emergency action plan (EAP) for recognizing and responding to cardiac arrest. It suggest that the plan be well rehearsed with separate protocols for games and practices due to differences in emergency medical access.

According to an article by Medical News Today, sudden cardiac death is the most common non-traumatic cause of death in college athletes and 75 percent of student-athlete deaths occur during sports and exercise. Current NCAA rules require all athletes undergo a PPE conducted by a licensed doctor, but do not define its purpose or require team physicians to conduct or review the exams. The NCAA convened a task force in 2014 to address concerns over cardiovascular care for athletes, which led to the consensus statement.

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