When the NCAA hired a neurologist two years ago to improve protocols for handling concussions, nobody foresaw that he would make a priority out of sudden cardiac death. But as the first chief medical officer in the history of the NCAA—an organization founded to promote athlete health— Brian Hainline has no intention of limiting his influence to neurology.
“Concussions have overshadowed everything,” says Hainline, a New York University neurologist. “Why aren’t we talking about death?”
In a series of interviews, Hainline disclosed that he is preparing to recommend this fall that athletes at higher risk of cardiac death, including male basketball players, be required to undergo an EKG test to search for cardiac defects. Such a recommendation wouldn’t obligate any school to follow it. But legal experts say that declining to follow the recommendation could place a school at risk of legal exposure if one of its male basketball players fell dead. Others note that the recommendation could create legal pressure to screen all college athletes, since cardiac death can strike in any sport, even if some research suggests that male basketball players are especially vulnerable.
“The message is giant: that [EKG] screening can help identify athletes that are at risk for cardiac disease,” says Jonathan Drezner, a University of Washington sports-medicine physician who believes that science supports such testing.
Hainline’s recommendation would represent the most radical effort to prevent cardiac death in college athletes since this danger hurtled into view exactly 25 years ago, when Loyola Marymount basketball star Hank Gathers fell dead of a heart defect during a game on March 4, 1990.
Since then, the American Heart Association has steadfastly urged caution in regard to screening apparently healthy young athletes with EKGs, in part because that test is prone to false positives.
When told of Hainline’s plan, Barry Maron, a Minneapolis cardiologist who is lead author of the AHA’s position papers on athlete screening, said, “This idea of screening selectively [with EKGs] is an unfortunate decision and initiative that will undoubtedly lead to unnecessary targeting (including by race), confusion, misdiagnosis, over-diagnosis and ultimately many unnecessary college-athlete disqualifications.”
Hainline, 59, took the NCAA job in January 2013 only after emphasizing that he didn’t need it and that he wouldn’t “rubber-stamp” policies he opposed. But if he is a renegade, he is also a deft politician. He knows that such testing already is performed by America’s professional sports leagues, and that it is endorsed by various sports and medicine groups, including the International Olympic Committee and European Society of Cardiology.
Moreover, a growing number of NCAA schools are doing so. A Wall Street Journal survey of the 65 schools that comprise the NCAA’s so-called power five conferences found that roughly half now require athletes to undergo either an EKG, which tests the electrical soundness of the heart, or an echocardiogram, which studies the structural soundness of the heart.
Of course, any discussion of the issue raises a question: How many NCAA athletes die of sudden cardiac death? At the time Hainline took the job, the NCAA had never tracked how many NCAA athletes died of any cause of death. Reporting of such deaths was purely voluntary. Based on that voluntary reporting and on media stories, at least nine NCAA athletes died of cardiac-related causes during the previous two school years.
On Hainline’s watch, the NCAA last year began requiring its members to report athlete deaths to the organization, including cause. Until that system produces data, the rate of cardiovascular death among NCAA athletes remains a matter of dispute between two different camps of researchers. The camp that favors EKG screening found that sudden cardiac death strikes about one in 43,000 NCAA athletes annually, or about eight a year. The camp that frowns on mandatory screening says that barely one in 100,000 NCAA athletes die a year from the condition.
Whose science is best is unknowable, since all of it is based on highly incomplete data. But Hainline clearly prefers action. “We have to do something about it,” he says.
Under Hainline, the NCAA enacted a rule that requires at least one person on a team’s staff to be trained in the use of an automated external defibrillator, which can restart a stalled heart. When a Tennessee State football player named Wayne Jones III collapsed and died of a heart defect at practice in November 2012, nobody on staff bothered using a defibrillator stationed less than 100 yards away, according to a lawsuit filed against the school by the player’s family and a deposition of the team’s former trainer. Tennessee State declined to comment.
Parents of NCAA athletes who have died of sudden cardiac death applaud Hainline’s focus on the issue. Pamela Bitsko, mother of Jason Bitsko, a Kent State football player who died following practice on Aug. 20, calls it crazy that he was tested for sickle-cell trait—a screen that the NCAA mandates—but not for heart conditions. Even though the Hainline recommendation wouldn’t apply to all football players, “anything they start doing is a step in the right direction,” she says. Trent Stratton, Kent State’s director of sports medicine, said the school has since considered whether to implement EKG testing but has no plans to do so…
As a physician, Hainline believes his primary concern should be athletes, not schools…
Hainline’s decision to recommend EKG testing of male college basketball players is based in part on a 2011 study in the journal Circulation showing a rate of death in Division I male basketball players of one in 3,100 a year. Still, the proposal is sure to be controversial. Such tests can’t identify every cardiac defect, and are prone to red flags in some athletes who have no defect at all, requiring additional tests to clear such players. Hainline wants to educate team physicians on how to read EKGs in a way that lowers false positives.
“I am trying to move the association, and sport in society, in a new direction,” he said. “We have a broken model of sport starting at the youth level. We take sport and we worship it. We forget who the human being is.”
SOURCE: Sharon Terlep, Wall Street Journal