Objectives The vast majority of sudden cardiac deaths (SCD) in young individuals occur in the absence of antecedent symptoms. Most deaths are due to hereditary or congenital cardiac abnormalities which can be diagnosed during life and therapeutic interventions are available to minimise the risk of SCD. In most Western countries screening of competitive athletes is supported by numerous sporting governing bodies. However, in the non-athletic population screening is confined only to those individuals with cardiovascular symptoms in the context of a family history of premature cardiac disease. Based on this strategy, most non-athletic individuals at risk of SCD would not be identified. In this study we assessed the impact of screening on the health service.
Methods Over a 3-month period 2671 subjects (mean age 18.8 years; range 14–35 years) were screened with a health questionnaire (HQ), and 12-lead electrocardiography (ECG). Screening was performed using a mobile trailer equipped with ECG and echocardiography machines and manned by cardiac physiologists and a cardiologist. The HQ related to symptoms suggestive of cardiovascular disease and a family history of premature SCD. ECGs were analysed by skilled cardiologists in accordance with the ESC sports cardiology consensus. Individuals with abnormalities on the HQ and/or ECG were investigated further with echocardiography performed on site. Individuals warranting further investigation even after this were referred for 24 h Holter monitoring and exercise stress testing.
Results Of the total 2671 individuals screened, 2415 (90.4%) had an entirely normal ECG with the remaining 256 (9.6%) requiring on site echocardiography. A further 163 individuals (6.1%) were reassured following echocardiography. Thus a total of 96.5% of all individuals screened were able to leave the mobile cardiac screening unit reassured that no cardiac disorder could be identified in one visit. Only 93 individuals (3.5%) required further investigation after ECG and echocardiography. Preliminary screening identified 16 individuals (0.59%) with cardiac disorders which could prove potentially fatal in five individuals (0.19%) (Brugada ECG pattern: n=2; Wolff-Parkinson-White: n=1; hypertrophic cardiomyopathy: n=1; right ventricular outflow tract ventricular tachycardia (RVOT-VT): n=1).
Conclusions Extrapolation of this data suggests large scale screening of non-athletic individuals (even in an expert setting) would be associated with a significant number of individuals (3.5%) requiring further investigation even after ECG and echocardiography. However, a huge proportion of individuals screened (96.5%) can be reassured in one visit. This is of particular relevance when considering that these individuals subsequently do not require primary and/or secondary care review.
- preparticipation screening
- sudden cardiac death
- general population