Athletes With Defibrillators Don’t Need To Quit Sports Reply

Although the American College of Cardiology and the European Society of Cardiology now advise people with ICDs not to participate in vigorous sports, a new study offers strong support for people with ICDs who want to take part in sports. Although a large number of people with ICDs are elderly heart failure patients who are unlikely to want to participate in sports, ICDs are also implanted in young and otherwise healthy people with genetic diseases that leave them at high risk for lethal arrhythmias.

Now findings from the ICD Sports Safety Registry, published in Circulation, provide vital new information about this important topic. The registry, which was performed with the assistance of patient advocacy groups, included 372 ICD patients between 10 and 60 years of age who participated in sports more vigorous than golf or bowling. The most common reasons for having an ICD among people in the registry were long-QT syndrome in 73 people, hypertrophic cardiomyopathy in 63 people, and arrhythmogenic right ventricular cardiomyopathy in 55. 60 subjects were college age or younger who took part in competitive sports.

Click here to read the full post on Forbes.

 

HOLLAND, MI - MARCH 7:  Fennville High School ...

 

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Model Finds High Cost For ECG Screening Of Athletes 2

A national program of ECG screening for U.S. athletes would save almost 5,000 lives over 20 years but would cost more than $50 billion dollars, according to a paper published in the Journal of the American College of Cardiology. The advisability of routine ECG screening for athletes has divided the experts: currently the ESC recommends ECG screening while the American Heart Association does not.

Israeli investigators developed a cost-projection model using data from a retrospective Italian study and based on population data derived from high school and college athletic associations and expense assumptions from Medicare. Currently there are more than 8.5 million student athletes. Over 20 years, the investigators predicted that a national screening program would result in 170 million ECG screenings and, based on an estimated 2% disqualification rate, 3.4 million disqualifications. This would cost between $51 and $69 billion dollars and save 4,813 lives, yielding a cost per life saved in the range of $10.6 to $14.4 million.

In an accompanying editorial comment, Antonio Pelliccia takes issue with the cost assumptions in the paper and maintains that pre-participation screening “should be priced as a package of preventive medicine program” rather than the more expensive individual diagnostic testing. He acknowledges that this “will require a change in the cultural attitude and current medical policy” in the U.S.

In a statement, the ACC said that automatic external defibrillators (AEDs) can be life saving “if used quickly on stricken athletes.” However, although AEDs are now commonly placed at sports venues and other public places, they “are only effective if actually used” and bystanders are often afraid to use them. “AEDs are life-saving,” said Joanne Foody, in the ACC statement. “While many fear they may cause more harm than good, it is not the case.”

Click here to read the ACC press release…

Guest Post: The Dark Side of EKG Screening in Athletes 1

The following guest post is reprinted with permission from , the blog written by Westby G. Fisher, a board certified internist, cardiologist, and cardiac electrophysiologist practicing at NorthShore University HealthSystem in Evanston, IL.

The Dark Side of EKG Screening in Athletes

by Westby Fisher

They sat nervously with their son in the doctor’s office, wondering why they were there.  John was, after all, the picture of health and had just received a scholarship to Stanford University to play soccer.  His mother and father had been to every soccer match through his formative years, enduring the travel schedule with its weekends away from home, long hours, horrible weather.  John was staring at his iPhone, his mother clutching a Kleenex.  John’s father stared out the window.  It was raining.

The door opened.

“Hello, I’m Dr. Kiljoy.  They asked me to see your son about a finding on his EKG.”

“Hello,” they said back.

“As you know, we’ve been looking into EKG’s in athletes because we have suspected for some time that an EKG will help us better detect students who might be at risk for sudden cardiac death while participating in sports.  You know, even if we can prevent one death in these young people, it would be worth it.  None of us want a young person to die.  That New York Times article yesterday… dang… with that crying family and all right there at the top… poor boy collapsed, people had no clue what happened at first, people thought he overheated, then waited… only later did they find that AED.  Then it didn’t work ’cause the battery was dead.  So sad!  We really are trying to prevent that from ever happening.  Seriously.  Sad as hell.  And to think we could have caught this if that teenager had just had an EKG…”

“Yes, of course!” said John’s mother.  “I’m SO glad you did this!  We’ll be so reassured to know that John’s going to be okay. “

A pause filled the room…

“He IS going to be okay, isn’t he?” she asked.

“Well, Mrs Smith, we’re not sure, we have to run some other tests.  You see he had a slight elevation to his ST segments in these leads here, see?  Then look at his heart rate, it’s so slow!  And that voltage here, it’s more than we usually see…  It’s probably okay, but I’m going to order an echo to look at his chamber sizes.”

“Okay…”

“And a then I’m going to have one of our EP people see him to make sure he doesn’t have a congenital ion channel disorder…”

“A what?”
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Half the News That’s Fit To Print: NY Times On ECG Screening For Student Athletes 6

There may be no more horrifying medical catastrophe than the sudden death of a young athlete on the playing field in front of a large crowd of friends, family, and community. But it’s also a dizzyingly complex subject with no easy solutions. Experts are divided. The American Heart Association recently reaffirmed that it does not recommend universal screening for potential cardiovascular disease in young athletes with electrocardiograms (ECGs). On the other hand, universal screening has been adopted, apparently successfully, in Italy.

According to Anahad O’Connor in the New York Times, however, the movement toward routine ECG screening for student athletes may be inexorable, as it is not just cost-effective but desirable from a medical and a societal perspective. The Times article states that sudden cardiac death (SCD) of young athletes “is far more prevalent… than previously believed.” About 2,000 children each year die from SCD, according to the American Academy of Pediatrics, as cited by the Times, but this includes all children, not just athletes. The Times quotes the mother of a young athlete who died: “this happens all the time.”

But the world’s leading expert on SCD, Barry Maron, of the Minneapolis Heart Institute, insists that there has been no noticeable change in prevalence, and that SCD in children– whether athletes or not– is a rare event.  “The peer reviewed data on this topic suggests that there are about 75 sudden cardiovascular deaths in competitive atheltes every year in the US,” he told me in an interview. (The Times article is similarly dizzy about the cost of an ECG test. Although medical costs are always a byzantine topic, the $1,400 cost cited in the article is preposterous. Move the decimal point one place: $140 is a lot closer to reality.)

O’Connor acknowledges that the AHA does not recommend universal screening, but argues that the position “pivots on old data.” He cites a 2010 study from Stanford published in Annals of Internal Medicine suggesting that ECG screening may be cost-effective, but doesn’t cite an accompanying article in the same issue that reached a much less positive conclusion. Also not mentioned is an editorial accompanying the articles, written by Maron himself, offering a number of reasons why widespread ECG  screening should not be widely adopted at this time. (Click here for my previous coverage of the Annals articles.)

Even the Stanford author tells the Times that “we are not advocating this as a mandatory test for all students or all athletes,” but the article moves on to quote another expert who thinks “the time has come for thorough heart screenings for all young athletes.” James Willerson, of the Texas Heart Institute, told O’Connor: “If we save even one life, it will be worth it.” But Willerson, who had a distinguished career as a cardiology thought leader, is not an expert in SCD, and has an important conflict of interest in this case. As mentioned in the Times article, Willerson has a $5 million private grant to screen 10,000 students in Houston middle schools.

In his interview with me Maron offered a far more balanced perspective. He acknowledged that “each of these deaths are greatly tragic, and it is never the intention to minimize it by citing numbers, however large and however small. Furthermore,” he continued, “no one would ever feel comfortable placing a monetary value on a young athlete’s life.”
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