Few Doctors Follow Sudden Cardiac Death Screening Guidelines for Athletes

Study Highlights:

  • Less than 6 percent of doctors said they completely follow national sudden cardiac death screening guidelines during physicals for high school athletes.
  • Many doctors and athletic directors are unaware the guidelines exist.
  • Better education and policies might increase doctor and school compliance, researchers said.

ORLANDO, Fla., Nov. 13, 2011 (GLOBE NEWSWIRE) -- According to a state survey, fewer than 6 percent of doctors fully follow national guidelines for assessing sudden cardiac death risk during high school sports physicals, researchers said at the American Heart Association's Scientific Sessions 2011.

The study was based on responses of 1,113 pediatricians and family doctors and 317 high school athletic directors in Washington state.

Less than half of the doctors and only 6 percent of the athletic directors reported that they were even aware of the guidelines. None of the athletic directors said their schools required physicals to comply with all guidelines.

In sudden cardiac arrest, the heart suddenly and unexpectedly stops beating due to an irregular heart rhythm. Without treatment, death occurs within minutes.

"A young person at the peak of physical prowess, dying without any warning — it's a shocking, tragic and potentially preventable death," said Nicolas Madsen, M.D., M.P.H., lead researcher and pediatric cardiology fellow at Seattle Children's Hospital and the University of Washington School of Medicine.

Recent studies suggest that among the more than 7 million U.S. high school athletes, one out of every 30,000 to 50,000 dies annually from out-of-hospital sudden cardiac arrest.

The American Heart Association published 12-point sudden cardiac death screening guidelines for athletes in 1996 and re-affirmed them in 2007. They consist of eight medical history questions and four physical exam elements, including listening to the heart and checking blood pressure.

Researchers sent 2,190 survey questionnaires by mail and email to pediatricians, family doctors and athletic directors over two months. The unusually high response rate — 56 percent to 75 percent — suggests a compelling interest in the issue, Madsen said.

Physicians were asked questions about pre-sports physicals. Athletic directors were asked about their school's requirements for physicals.

Researchers then used regression analysis and other techniques to determine the level of compliance with national guidelines.

Doctors reported missing several critical questions during screenings:

  • 28 percent didn't always ask about chest pain during exercise;
  • 22 percent didn't always ask about unexplained fainting;
  • 26 percent didn't always ask about a family history of early death;
  • 67 percent didn't always ask about a family history of heart disease.

Study results didn't change with the doctor's specialty, level of experience, location or the athletes' school size. Screening frequency and familiarity with the guidelines were linked to greater compliance.

"We need new directions to educate providers and improve policy requirements so patients can actually benefit from these national recommendations," Madsen said.

The doctors and athletic directors unanimously supported adopting a statewide form incorporating national screening guidelines. Parents should ask doctors and schools if a standardized form is being used, Madsen said.

Co-authors are: Jonathan Drezner, M.D. and Jack Salerno, M.D. Author disclosures are on the abstract.

Statements and conclusions of study authors that are presented at American Heart Association scientific meetings are solely those of the study authors and do not necessarily reflect association policy or position. The association makes no representation or warranty as to their accuracy or reliability. The association receives funding primarily from individuals; foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific association programs and events. The association has strict policies to prevent these relationships from influencing the science content.  Revenues from pharmaceutical and device corporations are available at www.heart.org/corporatefunding.  

NR11-1131 (SS11/Madsen)

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Abstract 15543 –Cardiac arrest screening can save lives, is cost effective

In an Italian study, sudden cardiac arrest screening — including medical history, 12-lead electrocardiogram and a physical exam — was cost-effective, with the cost per year of life saved totaling 50,000 Euros (about $69,000 U.S.).

Researchers analyzed costs and death rates over 26 years, before and after implementing the screening.

Note: Actual presentation is 3 p.m. ET, Monday, Nov. 14, 2011.

Abstract 17252 – State registry of athletes screened for sudden cardiac arrest is feasible

Establishing a statewide registry for athletes screened for sudden cardiac death risks is feasible, but long-term research and cost-effectiveness analyses should be conducted first, according to a study.

Researchers screened 1,002 high school athletes for sudden cardiac death risks using medical history, 12-lead electrocardiogram and echocardiogram data.

Note: Actual presentation is 3 p.m. ET, Monday, Nov. 14, 2011.

Abstract 17483 – Low-cost screening identifies students at risk for sudden cardiac death

A quick, low-cost screening model effectively identified high school students at risk for sudden cardiac death while reducing chances of false positives, researchers said.  Volunteer physicians and technicians at four hospitals screened 5,861 high school students for sudden cardiac death risk, using risk questionnaires, 12-lead electrocardiograms and quick-look echocardiograms.

Note: Actual presentation is 3 p.m. ET, Monday, Nov. 14, 2011.

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