Cost and yield of adding electrocardiography to history and physical in screening Division I intercollegiate athletes: A 5-year experience

Accuracy of ECG-inclusive preparticipation screening in athletes: more work to be done

“…The addition of ECG to PPS improved the ability to definitively exclude underlying cardiovascular disease (NPV = 99.8%; 95% CI: 98.7-100.0%) but came with the cost of decreased PPV (10.4%; 95% CI: 5.1-18.3%) due to a marked and likely unacceptable rate of false-positive ECG findings. Two subsequent studies in similar populations, one with [10] and one without comprehensive echocardiography [11], have presented similar findings. In aggregate, the limited available data suggest that the accuracy of ECG-inclusive PPS is a 'mixed bag.'…”

Assessment of the 12-Lead ECG as a Screening Test for Detection of Cardiovascular Disease in Healthy General Populations of Young People (12–25 Years of Age)

“…248 One study of 1473 NCAA Division I college athletes over 5 years measured the cost of adding ECGs to the screening history and physical examination. 228 Using the criteria of the ESC pertaining to ECGs, the cost per abnormal finding ($68 836) did not differ significantly between the strategies of history and physical examination alone versus the addition of ECGs. The ECG was more sensitive, identifying 8 more cardiac abnormalities than the 5 detected by examination; however, only 1 of these abnormalities could be considered clinically significant (LQTS); the false-positive rate was high (19%), and 2 athletes were disqualified.…”

“…247a,248 There are conflicting data estimating the cost per year of life saved in screening models with ECGs that justify closer scrutiny. 92,101,228,[248][249][250][251] Wheeler et al 248 calculated this measure for US competitive athletes. Although this assessment is useful, it potentially underestimates costs by using the data from Veneto to estimate risk (given that it is modeled largely on mortality attributable to ARVC/D and not HCM.…”

Eligibility and Disqualification Recommendations for Competitive Athletes With Cardiovascular Abnormalities: Task Force 2: Preparticipation Screening for Cardiovascular Disease in Competitive Athletes

“…[1][2][3] Indeed, sudden cardiovascular deaths in athletes are rare (albeit tragic) events, insufficient in number to be judged as a major public health problem or to justify a change in national healthcare policy. The most frequently cited obstacles to mandatory national screening of trained athletes are as follows: (1) the large number of athletes to be screened nationally on an annual basis (ie, ≈10-12 million); (2) the low incidence of events 1,8,10,11,18,[24][25][26] ; (3) the substantial number of expected falsenegative and false-positive results, in the range of 5% to 20% depending on the specific ECG criteria used [1][2][3][28][29][30][31][32] ; (4) cost-efficacy considerations, that is, the extensive resources and expenses required versus few events in absolute numbers; (5) liability issues that unavoidably impact physicians with the sole responsibility to disqualify athletes from competition and enforce that decision; (6) the lack of resources or physicians dedicated to performing examinations and interpreting ECGs, in contrast to the longstanding sports medicine program in Italy [4][5][6]9 ; (7) the influence of observer variability, technical considerations, and the impact of ethnicity/race on the interpretation of ECGs, which is particularly important for multicultural athlete populations such as in the United States; (8) the need for repetitive (ie, annual) ECG screening during adolescence, given the possibility of developing phenotypic evidence of cardiomyopathies during this time period or later 33 ; (9) the logistical challenges and costs related to second-tier confirmatory screening with imaging and other testing, should primary evaluations raise the suspicion of cardiac disease; and (10) recognition that even with testing, screening cannot be expected to identify all athletes with important cardiovascular abnormalities, and a significant false-negative rate may occur. 34 …”