Introduction Sudden cardiac death in the young is commonly due to inherited cardiac diseases that can be detected during life. Several scientific and sporting associations recommend pre-participation screening with ECG in young athletes to detect those at risk. Antagonists have questioned the cost effectiveness of such practice and the ethics of confining screening to athletes when consideration is given to the fact that most cardiac deaths in the young affect non-athletes. This study reports the diagnostic yield and financial implications of detecting potentially sinister diseases in young individuals in the UK.
Methods Between 2011–2012, 18,137 individuals nationwide aged 14–35 years underwent cardiovascular evaluation at a cost of £35 per person with a health questionnaire and physical examination (H+P) conducted by a cardiologist and an ECG interpreted in line with the 2010 ESC recommendations. On site echocardiography was performed in those considered to have abnormalities on preliminary assessment at no extra cost. Individuals requiring further evaluation were referred to secondary care. Follow up data was available in 75% of referred individuals.
Results 2,786 (15%) elite athletes undergoing pre-participation screening and 15,351 (85%) self-presenting and apparently healthy general population subjects were evaluated. 7.5% (n = 209) athletes and 9.7% (n = 1,495) general population subjects were considered to have abnormalities on preliminary assessment. On site echocardiography reduced referral for further evaluation by 53% (n = 111) in athletes and 61% (n = 905) in the general population. The predominant reason for referral in both groups was an ECG abnormality. Athletes were less likely to be referred for abnormalities on H+P. The prevalence of sinister cardiac diseases was similar in both groups; however, the cost per diagnosis was twice as expensive in the general population (Table 1).
Conclusion The cost of diagnosing a sudden cardiac death associated condition in the young ranges from £17,709 to £31,616. In the current financial era, this model may offer an effective alternative outside a national screening program; however, the data is based on heavily subsidised preliminary investigations and relatively modest tariffs of further evaluation in the National Health Service (NHS) and therefore such practice may not be feasible in other healthcare models.
- Sudden cardiac death
- Health Economics
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