A recent survey of physicians in the state of Washington found that fewer than half of them were familiar with student-athlete heart screening guidelines and only 6% actually incorporated those guidelines into their own practices. This is an important finding given the regular news reports of teenagers collapsing from sudden cardiac arrest at sporting events.
This has sparked a debate within the medical profession about the best way to screen prospective student-athletes for cardiac risks. Many in the medical community debate the use of electrocardiograms, echocardiograms or other tests for athletes. Others argue that the focus should first be on developing and implementing uniform standards and reporting methods nationwide.
“The process is so random in its current form that we don’t know where improvement needs to start”, said Nicolas L. Madsen, MD, MPH, a pediatric cardiology fellow at Seattle’s Children’s Hospital in an interview with the American Medical Association. “Before moving forward with new screening methods, it’s important to standardize the process so that we can really tell what works and what doesn’t”.
There is currently no mandatory reporting mechanism for such deaths. Recent estimates have ranged from 1 in 30,000 to 1 in 200,000 high athletes alone who die annually from sudden cardiac arrest. While there are national guidelines for cardiac risk screening, no one knows how often they are used. The American Heart Association’s (AHA) 12-point sudden cardiac arrest guidelines were first formulated and published in 1996. They include an examination and collecting through family medical histories. Yet the recent survey of 1113 physicians in Washington found that fewer than 50% of them were even aware of the guidelines and only 6% of them actually followed them fully in their examinations. This information was presented on Nov. 13, 2011 at the AHA Scientific Sessions conference in Orlando, Florida.
It should be little surprise that there is a need to educate medical professionals. The AHA last published the guidelines in 2007 in its publication, Circulation. That is primarily read by cardiologists. Physical exams administered to prospective athletes are performed by internists, pediatricians, family practice doctors, physician assistants and nurse practitioners. In some instances work is done by residents and even physical trainers. There currently is no uniform way to make sure all of these people receive up-to-date information.
Many of these exams are performed in noisy settings such as gymnasiums. It may be difficult for doctors to listen for warning signs such as irregular heartbeats. High school athletes frequently come without their parents. The athletes often have little knowledge of family medical histories so this information is not recorded. Athletes may also not disclose information to doctors if they think such disclosure may keep them from being able to play.
There is no standardization as to what kinds of forms are used and what information is sought in these physicals. This varies widely across the country and makes it even more difficult to accurately study problems in this area. Physicians argue that only schools and athletic associations can act to standardize the information sought.
One other problem is money. Many schools want to hold costs down for athletes or even offer exams for free. When this is a primary consideration it can affect the type of information sought and the testing done during these exams.
There is no question that sudden cardiac arrest is a problem for young athletes. It is probably past the time when the issues mentioned here should be addressed. Nothing can ever prevent all deaths from sudden cardiac arrest. Yet even with all of the publicity about this problem many areas of the country do not have good screening programs in place and often don’t even have heart defibrillators available at sporting events.
How many lives have to be lost before this issue receives widespread attention? To read more go to the American Medical Association website at http://www.ama-assn.org/amednews/2011/11/21/hlsa1121.htm.
The United States Sports Academy is committed to helping get the word out on health issues facing athletes. One example of this is the Academy’s recent efforts to get the word out about a promising east-to-use sideline test for detecting concussions, the King-Devick test. The Academy recently sponsored a seminar on this topic and is working with Dr. Steve Devick and others to publicize the benefits of this test. For more information on this topic, go to http:ussa.edu and search for information on the test.