From ATPM & ACPM

Screening for Sudden Cardiac Death Before Participation in High School and Collegiate Sports: American College of Preventive Medicine Position Statement on Preventive Practice

The College’s Current Position

The American College of Preventive Medicine (ACPM) supports an evaluation prior to participating in high school and collegiate sports using a standardized history and physical (H&P) (i.e., using standardized items as developed by the American Heart Association [AHA] to ensure uniformity and consistency in risk factor assessment; Table 1).¹ ACPM recommends against routine screening for potential sudden cardiac death (SCD) with electrocardiogram (ECG), echocardiography, and genetic testing in

Background

The risk of sudden cardiac death among high school athletes in U.S. is 0.7/100,000 person-years.³ The incidence of deaths among athletes due to cardiovascular collapse is twice that caused by trauma associated with sports.⁴ SCD is more common in men than in women at a ratio of 5:1 to 9:1.⁵ White athletes appear to be more affected than other races (55% vs 45%); however, the incidence of SCD due to hypertrophic cardiomyopathy is higher in African-American athletes.⁶ In 30%–50% of sudden cardiac

Supporting Evidence/Areas of Incomplete or Lacking Data

Studies addressing the efficacy of screening with clinical outcomes are currently lacking, and the utility of specific screening modalities remains unclear. An H&P developed by the AHA, which includes 12 criteria comprising personal and family history and a physical examination,¹ is widely used, although opinions differ about its usefulness. Although an H&P costs less, requires minimal resources, and is efficient to administer, it has low sensitivity in detecting hypertrophic cardiomyopathy and

Recommendations of Other Societies

The American Heart Association: Recommends cardiovascular pre-participation screening with a focused H&P to identify or raise the suspicion of those cardiovascular diseases known to cause sudden cardiac death or disease progression. The AHA recommends against ECG as universal screening because of its low specificity and costly additional workups.18, 19, 20

European Society of Cardiologists: Recommends screening all young competitive athletes with a complete H&P and 12-lead ECG.21, 22

Rationale for the College’s Current Position

The American College of Preventive Medicine acknowledges that studies addressing the efficacy of screening with clinical outcomes are lacking and that the utility of specific screening modalities remains unclear. However, at the present time, the H&P is the most widely used modality for pre-participation evaluation despite its limited sensitivity in detecting certain cardiac conditions. Promoting an H&P using standardized items as that developed by the AHA will ensure uniformity and consistency

Acknowledgments

The authors would like to acknowledge the assistance of the ACPM Prevention Practice Committee in developing this position statement, the ACPM Board of Regents for their additional comments and final approval of the document, and ACPM staff member Andrea Lowe, MPH, CPH, for her assistance in submitting this manuscript.

The following members of the ACPM Prevention Practice Committee participated in the development of this Position Statement: Gershon Bergeisen, MD, FACPM, Michael T. Compton, MD,