Routine heart tests for student athletes would be affordable
and potentially prevent the sudden deaths of young people who have previously
undiagnosed heart problems, according to a study by Stanford researchers
published today.
But many doctors, on learning of the findings Monday, said
that doesn't necessarily mean the tests should become the norm. Heart screening
in young people raises the possibility of false-positive results that could
delay an athlete's career, and there are other ethical issues, they said.
“Sudden death in young people is a devastating event that
every doctor and every parent wants to prevent. This study suggests it’s a
reasonable option to do screening. But it’s a close call,” said Dr. Anthony
Steimle, chief of cardiology at Kaiser Permanente in Santa Clara. “You might
disqualify a sizable number of athletes who don't need to be disqualified, in
order to prevent a terrible event in a few people.”
Sudden deaths of young athletes on the playing field are
rare—about 90 athletes die each year nationwide, most of them from heart
problems—but they capture the public’s attention when they happen because the
victims invariably appeared healthy and strong before collapsing.
Often such high-profile tragedies lead to public pleas for
screening to identify heart problems before they can become fatal. The American
Heart Association already recommends that all student athletes get annual
physicals and divulge to their physicians any family history of heart problems.
But routine screening with electrocardiograms has been
controversial, primarily because the procedure has been considered too
expensive for the number of lives it might save. The Stanford study, which was
published in today's issue of the Annals of Internal Medicine, is among the first to suggest that routine heart
tests are cost-effective.
The Italian model
To determine that, the researchers looked at policies in
Italy, where all athletes up to age 35 are required to get an electrocardiogram
before they’re permitted to participate in organized sports.
Applying the Italian model to American student athletes, the
Stanford researchers found that routine screening would cost $199 per athlete
and save 2.6 life years per 1,000 athletes. “Life years” is a standard way to
measure the benefit of a given treatment, based on how many more years people
would be expected to live if they are treated. For example, preventing the
heart-related death of one 15-year-old would result in about 50 life years
saved.
“Our main hope is that this study elevates the level of
debate,” said Dr. Matthew Wheeler, fellow in cardiovascular medicine at
Stanford University School of Medicine and lead author of the study.
While several doctors praised the Stanford research, they
added that it also points to a need for further study. They noted that even if
it is generally accepted that routine heart tests would be cost-effective, that
doesn't mean they would be the right choice.
Ethical questions
Regular screening raises some ethical questions. For
example, some doctors argue that it might not be fair to test only athletes for
heart problems, when all other students might benefit from screening. There's
also the matter of letting athletes and their families decide for themselves
what an acceptable risk is before automatically disqualifying them from sports.
Additionally, electrocardiograms frequently give false
positive results, said Dr. Kishor Avasarala, a pediatric cardiologist at
Children’s Hospital Oakland. That means that some young people would be forced
to get further testing—causing stress, adding expense and possibly delaying a
student’s athletic career.
That might seem a worthwhile exchange for saving lives, but
for many students, delaying an athletic career could mean risking a college
scholarship, or keeping a young person out of sports entirely.
“We can justify it with ‘We're trying to save lives’ and
‘What is the cost of one life vs. missing one season of athletics?’” Avasarala
said. “There are still questions about the real efficacy of screening.”
SOURCE: San Francisco Chronicle