Background/aim Screening of young competitive athletes remains a contentious issue. In 2010, a nationwide cardiac screening for all elite rugby players was introduced in England. This provided a unique opportunity to prospectively assess the feasibility and cost-effectiveness of a de novo, ECG-based cardiac screening programme.
Methods Between 2010 and 2012, 1191 rugby players aged ≥14 years underwent cardiac screening with a health questionnaire, 12-lead ECG and a consultation with a cardiologist. The players with concerning findings on initial evaluation were offered on-site transthoracic echocardiogram (TTE). Athletes were referred for further investigations as deemed necessary. The overall cost of the screening programme was estimated.
Results After initial evaluation, 9.7% of athletes underwent on-site TTE; 8.2% underwent on-site TTE due to ECG anomalies and 1.4% underwent on-site TTE due to concerns on the questionnaire. After TTE, only 2.9% of the total cohort was referred for further evaluation. Two players were diagnosed with potentially serious conditions; one with Wolff-Parkinson-White, who resumed competition after catheter ablation, and one with hypertrophic cardiomyopathy, who withdrew from competition. During a mean follow-up of 52.8±5.5 months, none of the players who were reassured experienced any adverse cardiac events. The total cost of the screening programme was £59 875, which averaged to a cost of £50 per player or £29 938 per condition identified. Application of refined ECG criteria would reduce the ECG false-positive rate to 4.9%.
Conclusions Preparticipation cardiac screening with 12-lead ECG is feasible. Refinement of the ECG criteria, the use of on-site TTE and expert setting can minimise the burden of unnecessary investigations and reduce costs.
- Athlete's heart
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Contributors SG, MP, AZ, NS, SG, HR, JS helped with data collection; SG and MP analysed the data and led the manuscript-writing process with contribution from others. SK, AS and CP facilitated the screening events; SS supervised the overall study and reviewed the manuscript. All authors approved the final manuscript.
Competing interests SG, MP, AZ, SG, NS, HR were funded by a research grants from the charitable organisation Cardiac Risk in the Young (CRY), which supports pre-participation screening of young athletes. SS has been a coapplicant on previous grants from CRY to study athletes.
Ethics approval National Research Ethics Service, Essex 2 Research Ethics Committee.
Provenance and peer review Not commissioned; externally peer reviewed.