SAN FRANCISCO -- A program that screened all students at a Chicago-area school for heart problems was clinically successful, but drew criticism for its broad scope and expected costs.

Among the more than 50,000 teens screened with electrocardiograms at school through the program, 2.16% showed significant abnormalities that required further follow up, Joseph C. Marek, MD, of the Midwest Heart Foundation in Oakbrook Terrace, Ill., and colleagues reported.

"It's feasible to do," Marek noted during his presentation at the Heart Rhythm Society meeting.

Pre-participation screening for student sports may prevent cases like that of high-school basketball player Wes Leonard, who died from sudden cardiac arrest in early March moments after scoring the winning shot for his team.

But most teens who do not participate in school sports are physically active even if just in gym class, Marek pointed out.

"Sports participation is a magnifier of these conditions [that predispose to sudden cardiac death]," he told MedPage Today, "but is a kid cheerleading any less important than the varsity quarterback? I don't think so."

While a single preventable death in any child is a tragedy, "the question has always been how much is society willing to spend to avoid that tragedy," Arthur Garson, MD, MPH, of the University of Virginia in Charlottesville.

Aside from the cost for screening, the costs associated with further testing, anxiety, and restriction from sports for false-positive test results have been controversial, as Garson and other experts explained via email to MedPage Today in collaboration withABC News.

Based on prior studies, ECG screening for the number of teens reported in the study could have been expected to produce about 1,500 false positives sent for further testing for every potential life saved, noted Barry Love, MD, director of pediatric electrophysiology at Mount Sinai School of Medicine in New York City.

The positive predictive value for an ECG abnormality as defined by Marek's group would be at most 10%, agreed Michael J. Ackerman, MD, PhD, of the Mayo Clinic in Rochester, Minn., and president of the Sudden Arrhythmia Death Syndromes Foundation.

Given the time and money needed to unwind the true diagnosis in these cases, this "collateral damage" rate may be unacceptable, he suggested.

Also, many of the at-risk students identified in such a screening program might have been caught later through other encounters with the healthcare system, noted Glenn Wetzel, MD, PhD, director of the arrhythmia service at Le Bonheur Children's Hospital in Memphis, Tenn.

The American Heart Association recommends pre-participation screening for competitive sports that includes physical examination and a family and personal medical history but not routine ECG.

Illinois requires this screening for all high school students, but Marek's group took the screening one step further by adding ECG in the Young Hearts for Life program.

It involved voluntary ECGs, performed during the school day at 32 Chicago suburban high schools, from 2006 through 2010. The ECGs were administered by trained community volunteers and read by cardiologists.

This strategy helped keep costs low, Marek noted. He estimated that an ECG runs about $9 alone, or less than $20 using the Medicare reimbursement rate for the physician charge.

Among the 50,665 students screened, 1,095 had ECG abnormalities that could be associated with sudden cardiac death. These cases included:

• Atrial enlargement indicated by ST-T changes (0.43% of total ECGs or 17.5% of abnormal ECGs)
• Left axis deviation (0.37% of total, 14.9% of abnormal)
• Prolonged QTc (0.29% of total, 11.7% of abnormal)
• Left ventricular hypertrophy (0.30% of total, 12.1% of abnormal)
• Right bundle branch block (0.17% of total, 7.0% of abnormal)
• Wolff-Parkinson-White syndrome (0.16% of total, 6.6% of abnormal)
• Right ventricular hypertrophy (0.15% of total, 6.1% of abnormal)
• Right axis deviation (0.10% of total, 4.2% of abnormal)
• Intraventricular conduction delay (0.07% of total, 2.7% of abnormal)

The community screened may be broadly generalizable to other suburban areas, Marek suggested.

"Our model using community volunteers works in our community," he noted in an interview, "but I think it's within the grasp of every community."

SOURCE: Med Page Today