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Mandatory ECG screening in Israel failed to lower sudden death, cardiac arrest risk
Bove A. J Am Coll Cardiol. 2011;57:1297-1298.
Steinvil A. J Am Coll Cardiol. 2011;57:1291-1296.
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Twelve years after Israel enacted the National Sport Law, which mandates electrocardiographic screening and exercise stress testing of all athletes, the incidence of cardiac arrest or sudden death did not change compared with 12 years before the law went into effect.
The National Sport Law requires that a medical questionnaire, physical examination, baseline ECG and exercise stress testing be completed by all athletes. Data for the current study were compiled by researchers during a systematic search of two main Israeli newspapers, which provided the yearly number of cardiac arrests among competitive athletes, whereas the Israel Sport Authority provided the size of the population at risk.
Between 1985 and 2009, 24 documented sudden death or cardiac arrest events occurred to competitive athletes, with 11 events reported 12 years before and 13 events reported 12 years after legislation. This resulted in an average yearly incidence of 2.6 events per 100,000 athlete years. Specifically, before legislation, the mean yearly incidence was 2.54 events per 100,000 athlete years vs. 2.66 events per 100,000 athlete years after legislation (P=.88).
“Sudden death among athletes is a very rare phenomenon,” the researchers wrote. “When the prevalence (or pretest probability) is so low, it is inevitable that many people with abnormal test results (abnormal ECG results) will represent false positive results. Of note, disqualification from participation in sports because of abnormal ECG results obtained during an obligatory (often unsolicited) screening has profound implications for the asymptomatic athlete. Therefore, before mandatory ECG screening is endorsed universally, it is reasonable to request additional proof that such a strategy actually saves lives.”
In an accompanying editorial, Alfred A. Bove, MD, PhD, with the Temple University School of Medicine, Philadelphia, said disqualifying athletes based on false positive ECG findings is a concern, and he made a suggestion on how physicians can limit the occurrence.
“At present, cardiologists who evaluate athletes should be familiar with the normal variants in echocardiography and ECG results and should incorporate the 12 questions posed by the American Heart Association for screening so that young athletes are not disqualified based on variant ECG results or normal cardiac adaptations to exercise,” Bove said.
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