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Screening recommendations reduce cost, frequency of ECGs for athletes
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The number of ECGs, workload and cost to screen patients who participate in sports were reduced when clinicians used international recommendations for ECG interpretation, according to a letter published in the Journal of the American College of Cardiology.
Harshil Dhutia, BSc, of the Centre for Inherited Cardiovascular Conditions and Sports Cardiology at St. George’s Hospital in London, and colleagues analyzed data from 4,925 athletes (85% men) aged 14 to 35 years from 2011 to 2014. Researchers analyzed health questionnaires, physical examinations and an ECG interpreted by the 2010 European Society of Cardiology recommendations.
Patients who had a positive screening were sent to hospitals for secondary investigations.
Abnormal physical examinations or health questionnaires were seen in 1.6% of patients (95% CI, 1.3-2). Three percent of patients (95% CI, 2.5-3.5) had positive ECGs with international recommendations, which represented a relative reduction compared with the 2010 ESC (86%), Seattle (50%) and refined criteria (30%; all 2-tail P < .0001).
Secondary investigations for abnormal ECGs read by international recommendations included exercise stress testing (1.2%; 95% CI, 0.9-1.5), transthoracic echocardiography (3.8%; 95% CI, 0.9-1.5), MRI (0.9%; 95% CI, 0.7-1.2), Holter monitoring (1%; 95% CI, 0.8-1.1) and other tests (0.4%; 95% CI, 0.3-0.7). Compared with the ESC recommendations, international recommendations contributed to a reduction in ECGs by 66%, Holter monitoring by 17%, exercise stress tests by 29% and cardiac MRIs by 25% (all 2-tail P < .001).
Using all four criteria for abnormal ECGs, 0.3% of patients were diagnosed with serious cardiac diseases.
International recommendations reduced the cost per athlete to $80 (95% CI, 75-91) and cost per serious diagnosis to $26,405 (95% CI, 24,392-29,833) vs. $92 and $30,251, respectively, for Seattle, $87 and $28,510, respectively, for refined and $110 and $35,993, respectively, for ESC criteria. International recommendations represented a relative cost reduction compared with the ESC (27%), Seattle (13%) and refined criteria (8%).
“Prospective evaluation is required to understand the actual impact of this consensus document on testing, cost and outcomes,” Dhutia and colleagues wrote. – by Darlene Dobkowski
Disclosures: The authors report no relevant financial disclosures.
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