Focused ultrasound cost-effective, improves athletes’ risk detection for cardiac death
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Key takeaways:
- Focused cardiac ultrasound improved the detection of sudden cardiac death-causing anomalies in athletes.
- Researchers determined that this approach was also cost-effective in this population.
Pre-participation screening for risk factors for sudden cardiac death with focused cardiac ultrasound was shown to improve diagnosis in athletes while remaining cost-effective, researchers reported.
“There are scarce data on the cost-effectiveness of integrating an echocardiogram in the pre-participation screening. Diagnostic requirements of a physician with experience in cardiovascular imaging and cardiovascular disease, time constraints and unclarified cost-effectiveness are likely barriers to its implementation,” Geza Halasz, MD, of the cardiology department at Azienda Ospedaliera San Camillo Forlanini in Rome, and colleagues wrote. “The main aim of this study was to prospectively assess in a large cohort of adult elite athletes the cost-effectiveness and diagnostic performance of a pre-participation screening including focused cardiac ultrasound examination vs. a clinically based approach and vs. an ECG-based approach.”
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Three approaches to pre-participation screening for cardiac conditions associated with sudden cardiac death were compared for their sensitivity, specificity and cost-effectiveness:
- model A: standardized family and medical history collection;
- model B: model A plus resting and stress ECG; and
- model C: model B plus a 10-minute focused cardiac ultrasound.
The results were published in the European Journal of Preventive Cardiology.
Among a cohort of 2,111 athletes (mean age, 25 years; 77.4% men), 30 were diagnosed with a cardiac condition associated with sudden cardiac death, three of whom were identified by model A, 14 by model B and 13 by model C, according to the study.
In the overall cohort, 0.6% of screened athletes were permanently excluded from competitive sports due to various conditions associated with risk for sudden cardiac death.
Addition of focused cardiac ultrasound in model C increased the sensitivity of pre-participation screening compared with models A and B (94% for model C vs. 19% for model A vs. 58% for model B) with similar specificity (93% for model C vs. 93% for model A vs. 92% for model B).
The total screening cost was 35.64 euros for model A, 87.68 euros for model B and 120.89 euros for model C.
Halasz and colleagues calculated that the incremental cost-effectiveness ratio was 135.62 euros for model B and 114.31 euros for model C, which the researchers deemed within conventional cost-effectiveness limits in most health care systems.
“A 10-minute focused cardiac ultrasound exam increased the specificity and, mostly, the sensitivity of the pre-participation screening of athletes at a reasonable cost,” the researchers wrote. “Pre-participation screening with focused cardiac ultrasound exhibited the highest cost-effectiveness per sudden cardiac death diagnosis. These results are consistent with the study hypothesis that adding a direct assessment of heart morphology and motion provides greater insight into sudden cardiac death risk of athletes than merely assessing its electrical activity or inferring this information from the clinical exam. Although the influence of focused cardiac ultrasound on sudden cardiac death mortality could not be determined, it did lower the need for specialist referral and identified athletes who were unsuited for competitive sports or needed clinical follow-up.”
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