Costs and yield of a 15-month preparticipation cardiovascular examination with ECG in 1070 young athletes in Switzerland: implications for routine ECG screening

Abstract

Cardiovascular preparticipation examination in young athletes using modern and athlete-specific criteria for interpreting ECG is feasible in Switzerland at reasonable cost. ECG alone is used to detect all potentially lethal cardiac diseases. The results of our study support the inclusion of ECG in routine preparticipation screening.

Modern standards of ECG interpretation in young athletes: Yield and effectiveness

“…The cost per athlete was 147 Swiss francs ($152) and 14,315 Swiss francs ($14,802) per finding [32]. Results from this study suggest that ECG screening can be feasible and performed at a reasonable cost when modern and athlete-specific criteria are used for ECG interpretation.…”

“…More recently, Menafoglio et al investigated 1070 Swiss athletes (mean age 19.7, 75% male) using a history, physical examination, and a resting ECG interpreted with adapted 2010 ESC Criteria [32]. The cost per athlete was 147 Swiss francs ($152) and 14,315 Swiss francs ($14,802) per finding [32].…”

“…Application of modern standards of ECG interpretation in athletes demonstrates a reduction in false positive rates to b 5% in several large-scale studies (a comprehensive review of studies to date using athlete-specific ECG interpretation criteria, the populations studied, total and false positive rates, pathologic findings, and conclusions is provided in online Supplementary material 2 or per request from the lead author) [15,16,23,[25][26][27][28][29][30][31][32][33][34][35][36][37][38][39]. For instance, a recent investigation examined the use of an ECG in a cohort of 2017 high school athletes from 18 high schools, representing diverse racial and socioeconomic backgrounds [33].…”

Results of a nationally implemented de novo cardiac screening programme in elite rugby players in England

“…These results should be viewed with caution as the respective studies exhibit several limitations; using theoretical projection models rather than true costs, extrapolating results from the Italian experience to US high-school athletes and making arbitrary assumptions relating to the life years saved by identifying a potentially life-threatening condition 27–29. In a Swiss study where the true NHS rates were used to assess the cost of screening of young athletic individuals, the authors reported costs of £108 per athlete screened and £29 000 per potentially life-threatening condition identified (three WPW, one LQTS) 30. Our study reports on a de novo nationwide screening programme of elite, professional athletes, and estimates costs using the subsidised screening fee required for our programme.…”

Sudden cardiac death in the young

“…Many such groups have demonstrated a high level of proficiency in structuring these programs. Although cardiovascular screening has been adopted as public policy and met with widespread acceptance in some countries, 49,88,129 practical concerns have limited enthusiasm for mandated screening in the US and elsewhere. 130 Chief among these are 1) the impact of false-positive findings, which include unnecessary work-up, proscription from sport or other desired, healthful or necessary activity, and possible creation of psychological harms, 115,116 2) the effect of inaccuracy in diagnosis to discount the potential value of cardiovascular screening in actual use [131][132][133] , and 3) the willingness of patients with positive screening tests to pursue further diagnosis and management.…”