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 An ECG measures the electrical activity of the heart
and can detect disturbances that could predispose people to rare but
dangerous cardiac arrests. Sudden cardiac death is the most common
cause of death during exercise, researchers note.
Italy and Israel mandate ECG screening as part of sports
pre-participation examinations, while the debate over whether to
require athletes to get the test has become increasingly contentious
in the United States.
One of the downsides of ECGs is that they sometimes suggest a heart
problem that turns out to be a false alarm upon further testing. In
the interim, athletes may fear for their health or their future in
sports.
“This is the first study to look at the psychological impact to
athletes when they get screened,” lead author Dr. Irfan Asif told
Reuters Health. “There’s nothing to indicate you shouldn’t get an
ECG because of stress.”
Asif, from the University of Tennessee Graduate School of Medicine
in Knoxville, and his team studied 952 high school athletes who
participated in a range of sports. The students all received a
medical history and physical examination to screen for underlying
heart problems. All but 150, who served as a comparison group, also
received an ECG.
Of the 802 participants who were screened with ECG, 220 had an
abnormal finding at some point during the screening process. Six of
those represented serious heart conditions, and the rest were false
positives.
Reviews of a student’s medical history led to 127 of the false
positives. An additional 50 false positives were a result of
physical exams, 14 were from ECG readings and 29 were due to
multiple indications.
The researchers found no difference in students’ distress levels
immediately after screening based on whether their testing had
included an ECG.
A 2007 American Heart Association statement on cardiovascular
screening warns that false-positive results from ECGs could lead to
unnecessary anxiety, the authors write in the British Journal of
Sports Medicine.
But the current investigation showed no differences in distress
levels based on the reason for the false-positive evaluation - the
vast majority of which resulted from a review of a student’s
personal and family medical history.
“The athletes we’ve interviewed are actually very grateful that
someone’s tried to save their lives,” Asif said. “We’re not really
seeing negative consequences. We’re seeing very positive benefits.”
But pediatric cardiologist Dr. Peter Fischbach from Children’s
Healthcare of Atlanta told Reuters Health the study protocol limited
its generalizability. Fischbach, who is also affiliated with Emory
University School of Medicine, was not involved with the new study.
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Students whose ECGs showed possible problems in the current
investigation had follow-up tests on the same day at the same
location. Most student-athletes have to wait for follow-up
appointments with cardiologists, Fischbach said.
“If you’re not allowed to practice until you get a note from a
cardiologist, and you have to go home and stew on it for three
weeks, I worry that kids would become a little more stressed out,”
he said. “Maybe they’d get a little more anxious and wonder if
they’re ever going to be able to play again.”
The authors acknowledge that on-site, same-day tests to evaluate the
abnormal ECG findings could have minimized anxiety among students.
“I imagine people having to wait for additional testing might have
anxiety,” Asif said.
He and Fischbach both said there should be ways to address delays in
follow-up in the real world.
But even if expected delays between tests could be shortened,
Fischbach said the problem of funding to screen all U.S.
student-athletes would remain. “In this era of cost-containment,
this has the potential to be an explosive cost,” he said.
Some doctors have called for regular testing of U.S.
student-athletes to try to prevent sudden cardiac deaths. So far,
though, data have failed to show that screening could reliably weed
out only the most at-risk youth at an affordable price. Based on
Italian data, British researchers have calculated that close to 800
athletes would have to be benched from their sports for every death
prevented (see Reuters Health story of October 11, 2012 here:
http://reut.rs/1oF5cHu).
Nevertheless, Asif believes in ECG screening. He noted that reviews
of family history and physical examinations are substantially flawed
in their ability to detect heart defects, yet schools require them
for students to participate in sports.
“People are asking for evidence. Where’s the evidence for a history
and physical?” he asked.
“My message is you should do all three,” he said. “With screening
with an ECG, we can save lives. Your ability to detect disease is
much higher, and it looks like it doesn’t cause additional anxiety
in people.”
SOURCE: http://bit.ly/RNbzKX British Journal of Sports Medicine,
online May 13, 2014.
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