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Preparticipation Screening of Athletes and Sudden Cardiac Death

A mandatory Italian screening program appeared to lower risk among young athletes.

Among high school and college athletes, sudden cardiac death usually is caused by structural heart disease that is difficult to detect in broad screening programs. In 1982, Italy instituted a mandatory preparticipation screening program for young athletes (age range, 12–35) that includes detailed history-taking, physical examinations, and electrocardiograms (ECG). The program’s effectiveness was assessed by comparing temporal trends in sudden death among screened athletes and unscreened nonathletes. Assessed intervals were prescreening (1979–1981), early-screening (1982–1992), and late-screening (1993–2004).

During the entire study period, in unscreened nonathletes, the incidence of sudden cardiac death was steady at about 0.8 per 100,000 person-years. In athletes, 55 cases of sudden cardiac death occurred; incidence declined from 4.2 per 100,000 person-years in the prescreening interval to 2.4 in early-screening and to 0.9 in late-screening. Most of the reduction was attributable to fewer deaths from hypertrophic obstructive cardiomyopathy and arrhythmogenic right ventricular cardiomyopathy (ARVC).

Comment: Among the many difficulties of generalizing these results to U.S. athletes, editorialists note that this was not a controlled intervention, the independent value of ECG could not be assessed, the prevalence of ARVC is much higher in Italy than in the U.S., the death rate prior to mandatory screening was high compared with that in most current studies, and the late-screening death rate is roughly the same as the current death rate for U.S. athletes. Although these findings do not provide a definitive answer about the best way to screen athletes cost-effectively, they do support a need for more rigorous study of this matter.

— Thomas L. Schwenk, MD

Published in Journal Watch General Medicine October 3, 2006

Citation(s):

Corrado D et al. Trends in sudden cardiovascular death in young competitive athletes after implementation of a preparticipation screening program. JAMA 2006 Oct 4; 296:1593-601.

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• Medline abstract (Free)

Thompson PD and Levine BD. Protecting athletes from sudden cardiac death. JAMA 2006 Oct 4; 296:1648-50.

• Original article (Subscription may be required)
• Medline abstract (Free)