Risk of sudden cardiac death in young athletes: which screening strategies are appropriate?

Bader, Rima S; Goldberg, Linn; Sahn, David J.

doi:10.1016/j.pcl.2004.04.005

Cited by 21 publications

(14 citation statements)

References 61 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The existing protocols ail include a medical history and a physical examination, in some cases diagnostic tests, of varying content. The persan performing the screening is also variable, some places allowing non-physicians [19,68,70,72,74,76,78,79,89,90] to conduct the examination, which decreases the chances of positive findings. One wonders what the results will be when technicians, nurses, chiropractors, or athletic trainers perform the cardiovascular screening.…”

Section: Discussionmentioning

confidence: 99%

Sudden cardiac death in athletes: the Lausanne Recommendations

Bille

Figueiras

Schamasch

et al. 2006

European Journal of Cardiovascular Prevention & Rehabilitat

214

190

View full text Add to dashboard Cite

Objectives This study reports on sudden cardiac death (SCD) in sport in the literature and aims at achieving a generally acceptable preparticipation screening protocol (PPSP) endorsed by the consensus meeting of the International Olympie Committee (IOC). Background The sudden death of athletes under 35 years engaged in competitive sports is a well-known occurrence; the incidence is higher in athletes ( ~ 2/1OO000 per year) than in non-athletes (2.5: 1 ), and the cause is cardiovascular in over 90%.Methods A systematic review of the literature identified causes of SCD, sex, age, underlying cardiac disease and the type of sport and PPSP in use. Methods necessary to detect pre-existing cardiac abnormalities are discussed to formulate a PPSP for the Medical Commission of the IOC.Results SCD occurred in 1101 (1966-2004) reported cases in athletes under 35 years, 50% had congenital anatomical heart disease and cardiomyopathies and 10% had early-onset atherosclerotic heart disease. Forty percent occurred in athletes un der 18 years, 33% under 16 years; the female/male ratio was 1 /9. SCD was reported in almost ail sports; most frequently involved were soccer (30%), basketball (25%) and running (15%). The PPSP were of varying quality and content. The IOC consensus meeting accepted the proposed Lausanne Recommendations based on this research and expert opinions (http://multimedia.olympic.org/pdf/en_report_886.pdf). Conclusion SCD occurs more frequently in young athletes, even those under the age of 18 years, than expected and is predominantly caused by pre-existing congenital cardiac abnormalities. Premature atherosclerotic disease forms another important cause in these young adults. A generally acceptable PPSP has been achieved by the IOC's acceptance of the Lausanne Recommendations. Eur J Cardiovasc Prev Rehabil 13:000-000

show abstract

Section: Discussionmentioning

confidence: 99%

Sudden cardiac death in athletes: the Lausanne Recommendations

Bille

Figueiras

Schamasch

et al. 2006

European Journal of Cardiovascular Prevention & Rehabilitat

214

190

View full text Add to dashboard Cite

show abstract

“…Over the last decade there has been increased focus on primary preventive strategies [3] such as (a) screening Questionnaire[4, 5] with utilization of disqualification criteria for participation in physical education and sports, (b) EKG and other investigations; and secondary preventive strategies [3] (a) automated external defibrillator (AED) [6] and (b) automated implantable cardioverter defibrillators (AICD) [7]. Although a screening Questionnaire is currently used for primary prevention of SCA, there is controversy regarding the use of additional testing such as a screening EKG.…”

Section: Introductionmentioning

confidence: 99%

Sudden Unexplained Cardiac Arrest in Apparently Healthy Children: A Single-Center Experience

et al. 2012

View full text Add to dashboard Cite

Objective To determine the causes of sudden cardiac arrest (SCA) in apparently healthy children in a single center in the era of primary prevention (screening questionnaire, SQ) and secondary prevention (automated external defibrillator, AED and automated implantable cardioverter defibrillator, AICD). Study Design Any child (0–18 year’s age) without prior known disease except for attention deficit disorder who underwent out-of-the hospital cardiopulmonary resuscitation was included in the study as SCA. Using retrospective chart review we evaluated the efficacy of the SQ, electrocardiogram (EKG), chest roentgenogram (CXR) and an echocardiogram. Results We found 44 out of 6,656 children admitted to intensive care with SCA; an AED was used in 39%, AICD placed in 18% and survival to hospital discharge was 50%. The etiology for SCA was identified in 57% of the cases, mostly in those above one year of age and among these the majority of had a cardiac etiology (50%) while 7% had rupture of an arteriovenous malformation. Stimulant medication use was seen in 11% of the SCA. In the best case scenario of hypothesized primary prevention, a prior SQ, CXR, EKG and echocardiogram may have detected 18%, 9%, 23% and 16% of at-risk cases respectively and 32% may have been detected with EKG and SQ together. Based on a historical control cohort, a positive EKG was significantly higher in children with SCA (p = 0.014). Conclusion An EKG along with a screening SQ may be more effective in identifying children who are potentially at-risk for SCA than a SQ alone.

show abstract

“…14 A similar debate has taken place about screening adolescents entering competitive athletics. 15 Strenuous exercise is a well-documented risk factor for arrhythmias leading to sudden death, 16 and this risk is greater in individuals with cardiac abnormalities such as hypertrophic cardiomyopathy, anomalous coronary artery, myocarditis, arrhythmogenic right ventricular dysplasia, or primary electric abnormalities like long-QT syndrome. 17 We conducted a cost-effectiveness analysis of 2 approaches for routine ECG screening in addition to H&P for children with ADHD to identify those at potential increased risk of SCD before prescribing stimulant treatment compared with the current standard strategy of cardiology assessment only in cases of potential cardiac abnormalities identified through H&P.…”

Section: Editorial See P 1283 Clinical Perspective On P 1337mentioning

confidence: 99%

Modeled Economic Evaluation of Alternative Strategies to Reduce Sudden Cardiac Death Among Children Treated for Attention Deficit/Hyperactivity Disorder

et al. 2010

View full text Add to dashboard Cite

Background-Stimulants are widely used to treat children with attention deficit/hyperactivity disorder and may increase the risk for sudden cardiac death (SCD). We examined the cost-effectiveness of pretreatment screening with ECG for reducing SCD risk in children diagnosed with attention deficit/hyperactivity disorder who are candidates for stimulant medication. Method and Results-We constructed a state-transition Markov model with 10 annual cycles spanning 7 to 17 years of age. Taking a societal perspective, we compared the cost-effectiveness of 3 screening strategies: (1) performing a history and physical examination with cardiology referral if abnormal (current standard of care); (2) performing a history and physical examination plus ECG after negative history and physical examination, with cardiology referral if either is abnormal; and (3) performing a history and physical examination plus ECG, with cardiology referral only if ECG is abnormal. Children identified with SCD-associated cardiac abnormalities would be restricted from stimulants and from playing competitive sports. The expected incremental cost-effectiveness over strategy 1 was $39 300 and $27 200 per quality-adjusted life-year for strategies 2 and 3, respectively. Monte Carlo simulation found that the chance of incremental cost-effectiveness was 55% for strategy 2 and 71% for strategy 3 (willingness to pay Յ$50 000 per quality-adjusted life-year). Both strategies 2 and 3 would avert 13 SCDs per 400 000 children seeking stimulant treatment for ADHD, for a cost of $1.6 million per life for strategy 2 and $1.2 million per life for strategy 3. Conclusions-Relative to current practice, adding ECG screening to history and physical examination pretreatment screening for children with attention deficit/hyperactivity disorder has borderline cost-effectiveness for preventing SCD. Relative cost-effectiveness may be improved by basing cardiology referral on ECG alone. Benefits of ECG screening arise primarily by restricting children identified with SCD risk from competitive sports. (Circulation. 2010;121:1329-1337.)

show abstract

Risk of sudden cardiac death in young athletes: which screening strategies are appropriate?

Cited by 21 publications

References 61 publications

Sudden cardiac death in athletes: the Lausanne Recommendations

Sudden cardiac death in athletes: the Lausanne Recommendations

Sudden Unexplained Cardiac Arrest in Apparently Healthy Children: A Single-Center Experience

Modeled Economic Evaluation of Alternative Strategies to Reduce Sudden Cardiac Death Among Children Treated for Attention Deficit/Hyperactivity Disorder

Contact Info

Product

Resources

About