Flower Mound Marcus coach Bryan Erwin has never had one of his football players suffer sudden cardiac arrest.
To help keep it that way, Erwin has taken a proactive approach to his players’ cardiovascular health.
Marcus football players at every level had the opportunity to undergo an electrocardiogram (ECG) and echocardiogram screening at a Flower Mound Walgreens this off-season. Ninety of them took advantage.
Irving-based healthcare company Frontera Strategies staffed the Walgreens with a sonographer, who sent the data to Dr. Jason Finkelstein, an interventional cardiologist with Advanced Heart Care. The results were relayed to the families and athletes within a week.
“We just want to make sure we’re on the cutting edge with everything we’re doing,” Erwin said. “This is becoming a very prevalent issue, so through Frontera, through Walgreens and through the Marcus football booster club, we’ve joined together to make this happen.”
It’s an ideal recipe for making affordable heart screenings available to high school athletes. In this case, Walgreens, a large national company, had the space to perform the tests, and Frontera, a regional company, possessed the staff.
The cost of the tests was reduced to $75. A trip to the doctor for the same tests would cost up to $600, Finkelstein said.
Flower Mound Marcus was the first school to receive this opportunity, but Walgreens market pharmacy director Frank Koven hopes to expand the program.
“It’s just the right thing to do,” Koven said.
What to mandate?
Some advocates of ECG screening would like to see it mandated across the state, and there was a push to do so at the most recent session of the Legislature.
House Bill 1319 would have required athletic participants in UIL events to have two ECGs during their high school careers. The bill did not get out of the public education committee in the House.
There are two main hurdles standing in the way of a successful mandate: cost and infrastructure.
The Journal of the American College of Cardiology published a study last year detailing the cost-benefit of national electrocardiographic screening. A 20-year program of ECG screening of young competitive athletes in the U.S. would cost between $51 billion and $69 billion and could be expected to save 4,813 lives.
That makes the cost of each life saved roughly $10.6 million to $14.3 million.
The screening itself represents only a fraction of the cost that would follow an abnormal result. An athlete whose tests reveal abnormalities would need to visit a cardiologist to determine the problem, which could range from a genetic defect to any number of structural or electrical disorders.
The diagnosis of the underlying problem and the subsequent treatment could cost tens of thousands of dollars.
Jonathan Drezner, a professor in the Department of Family Medicine at the University of Washington, said the high cost in the JACC conclusion is largely a symptom of a bad infrastructure.
Drezner is the team physician for the Seattle Seahawks and the University of Washington Huskies, and he performs ECGs on every athlete in his programs. He’s a staunch advocate for the test because it provides a better screen for heart health than a physical alone — but only if it’s performed by doctors who can properly interpret the results, he said.
Drezner argues that there aren’t enough doctors adequately trained in interpreting ECGs to accommodate running the test on every athlete at a state or national level. The result of mandating these tests now, he said, would be a high false-positive rate, which would lead to more follow-up visits and mounting costs.
“In the sports medicine community, we’re really interested in trying to improve this,” Drezner said. “I don’t think that includes mandatory or legislative programs. I think it includes physician education.”
Drezner said he operates with a 3 percent false-positive rate, well below a national average of 5 to 10 percent. He said roughly 10 percent of patients who have an abnormal screen actually end up having a problem.
Rather than mandate ECG screenings for all athletes, Drezner said a better place to start would be to test those at the highest risk. In his own research, Drezner found that black males are at the highest risk and that basketball and football players accounted for roughly 60 percent of sudden cardiac deaths.
“What I hope is that if a state is thinking of mandating this that they provide the resources for follow-up,” Drezner said. “Most hospitals have a charity line of care that they’re willing to access for this purpose.”
The enormous costs and the inadequate infrastructure to accommodate testing every athlete make cardiologists reluctant to support a mandate.
“I really wouldn’t say there’s an urgency to get testing done,” Finkelstein said. “But if a child has participated in sports and they’ve had issues where they’ve passed out, or had chest pain or there’s a history of sudden cardiac arrest, then I would recommend going further and at least seeing your family doctor.”
SOURCE: DallasNews.com