A mandatory screening program of athletes that involves an electrocardiogram (ECG) before participating in sports does not reduce the incidence of sudden death, according to a new analysis  reported in heartwire.org. The new data, from Israel, where a mandatory medical screening program has been in place since 1997, show that the incidence of sudden death or cardiac arrest did not decline with the introduction of the preparticipation screening protocol.
From 1985 to 2009, there were 24 documented cases of sudden death or cardiac arrest among competitive athletes, with 11 cases occurring prior to 1997 when the Israel Sport Regulations on Athletes Medical Testing was enacted, and 13 events occurring after the legislation. During this time, the average yearly incidence was 2.6 events per 100 000 athlete-years, a rate that was nearly identical in the decade before and after the mandatory medical screening was put in place.
Overall, the incidence of sudden death or cardiac arrest was 2.6 events per 100,000 athlete years. Prior to mandatory ECG screening, the incidence was 2.54 events per 100,000 athlete-years, while it was 2.66 events per 100 000 athlete-years in the decade following legislation (p=0.88). The data challenge the benefits of screening observed in Italy and are consistent with results observed in Denmark and Minnesota, said Viskin.
"There is an ethical issue about whether screening should be mandatory," Dr Sami Viskin (Tel-Aviv University, Israel), the senior investigator of the Israeli analysis. "The evidence showing that colonoscopy reduces death from colon cancer is larger by several orders of magnitude than the evidence showing that screening does anything for athletes, but I don't know if society would tolerate a law mandating that everybody must undergo a colonoscopy once they're over the age of 50. Mandatory ECG screening is performed in pilots and in soldiers, but here we have a population of people who want to play sports, most for fun, some for a living, and we're forcing them to undergo a test that will affect their lives. The question is whether screening should be mandatory when there is limited proof supporting it."
- Steinvil A, Chundadze T, Zeltser D, et al. Mandatory electrocardiographic screening of athletes to reduce their risk for sudden death. J Am Coll Cardiol 2011; 57:1291-1296.
- Bove AA. Making or breaking athletic careers. J Am Coll Cardiol 2011; 57:1297-1298.