(Editor’s Note. This article was originally published in the San Francisco Examiner. It then appeared on the paper’s website at http://sfgate.com. It was subsequently posted on the website for the Athletic Business Magazine at http://athleticbusiness.com. This is posted here because it is a very important and timely topic that should interest anyone working in sports administration or coaching).
Stanford researchers on Monday released the first-ever guidelines for reading heart tests of young athletes and using the results to predict who may suffer from hidden but potentially deadly heart defects.
Using electrocardiograms to screen athletes for heart problems has been debated by parents, coaches and sports doctors for years. Some parents and doctors argue screening could prevent the rare but heartbreaking sudden deaths of athletes on playing fields.
But electrocardiograms aren’t perfect and often result in false-positive results that could lead to some athletes being banned from playing and dashing hopes of college scholarships or sports careers.
The new guidelines, published in Monday’s issue of the journal Circulation, would make it easier for doctors to read the electrocardiograms of young athletes, the authors say, and therefore lead to more accurate testing and fewer false positives.
“We’d like doctors to understand what is normal and what shouldn’t be missed in young athletes,” said Dr. Vic Froelicher, a Stanford cardiologist and senior author of the new guidelines. “We don’t want a lot of false-positive calls, because that can have incredible repercussions for young people. We want this test to be the best it can be.”
Heart problems
Roughly 75 to 100 teenagers and young adults die in the United States each year during athletic events, most often from undiagnosed heart problems. With more than 10 million young people playing organized sports every year, sudden deaths are very rare. But they tend to capture public attention because the victims are so young and usually appear healthy and strong before they collapse.
Current recommendations by the American Heart Association and several doctors’ and public health organizations call for a thorough physical exam, including a look at the athlete’s family history, before young people are allowed to play competitive sports.
But many parents and a growing number of physicians are calling for a universal screening of young athletes with electrocardiograms to identify hidden heart problems. A study out of Stanford last year suggested that routine screening would be affordable – about $200 per athlete– and life-saving.
Already many professional sports teams require electrocardiogram testing, and many sports doctors argue that top-level college and high school athletes practice and play with an intensity that is close to the pros. Stanford has offered voluntary screening for student athletes since 2007.
Screening opponents
Still, opponents to universal screening say that with millions of people playing sports in the United States, it’s impractical to screen every athlete. And aside from that, electrocardiograms aren’t the best tool for screening, they say – results are often subjective and open to interpretation.
In fact, another study out of Stanford published last month suggested that most cardiologists aren’t very good at reading the electrocardiogram results of athletes, whose tests may look different than a normal but less active adult.
“The debate has been going on for quite a long time as to how to prevent sudden death in athletes,” said Dr. Anne Dubin, medical director of pediatric arrhythmia at Packard Children’s Hospital and one of the authors of last month’s electrocardiogram study. “The problem is how to do this. If we do these tests, can anyone even read themf”?
That’s what the new guidelines aim to resolve, or at least improve upon. The guidelines address a dozen possible readings from an electrocardiogram, paying particular attention to how those readings may look in a young athlete compared with a nonathletic adult.
False positives
The Stanford researchers studied 658 athletes who had undergone electrocardiogram screening. At the time they were screened, 63 of the athletes had an abnormal electrocardiogram result and needed further testing. But applying the new guidelines, only 29 of the athletes would have had an abnormal result.
In other words, the new guidelines would still catch athletes with possible heart problems, but they would result in fewer false positives, the authors said.
It’s a step in the right direction, several doctors said Monday. But many cardiologists were still reluctant to encourage widespread screening of athletes.
Dr. Kathleen Newkumet, a private cardiologist who works out of Oakland Children’s Hospital and regularly performs electrocardiograms on young athletes, said she’s been approached by community groups several times about performing mass screenings for school districts or large sports organizations.
“But once I tell them that we can’t provide absolute reassurance, they’re less excited,” she said. “There’s a whole range of variation and interpretation to electrocardiograms. They’re kind of like a Rorschach test. They’re not as straightforward as people think.”
Stanford offers voluntary heart screenings for student athletes, like football players Griff Whalen and Drew Terrell. Lacy Atkins / The Chronicle