ClinicalGeneralCost and yield of adding electrocardiography to history and physical in screening Division I intercollegiate athletes: A 5-year experience
Introduction
Preparticipation athletic screening with electrocardiograms (ECGs) is controversial. Whereas European Society of Cardiology (ESC) guidelines1 recommend preparticipation ECGs in addition to history and physical in all competitive athletes younger than 35 years, the American Heart Association (AHA)2, 3 in the United States recommends only history and physical without ECG. The rationale for these two recommendations rests on disparate findings regarding cost and yield. One potential reason for this is that the United States is more ethnically diverse and thus may have a different prevalence of any given genetic condition. For example, in Italy, the incidence of arrhythmogenic right ventricular cardiomyopathy (ARVC) appears to be higher than in the United States.4 The U.S. population has grown more diverse, and few data from the modern era are available on the cost and yield of ECG screening in a U.S. college population. The few studies that exist include fewer than 600 patients.5 At the University of Virginia, we have performed ECG screening in all 1,473 competitive athletes since 2005. We report the yield and cost of an ECG screening program in addition to history and physical in a National Collegiate Athletic Association Division I college athlete population, the most elite of the U.S. college athlete divisions.
Section snippets
Methods
From 2005 to 2010, all 1,473 National Collegiate Athletic Association Division I athletes regardless of sport underwent screening with history and physical and with ECG. The screening was a requirement that was disclosed to athletes and their parents prior to the athletes accepting an athletic position at the University of Virginia. The history and physical was performed by a team of physicians, including two internists with input from a cardiologist. Tests including echocardiograms were
Athlete demographics
Demographic information of athletes screened is given in Table 1. Of the athletes, 741 (51%) were women. Racial distribution was white (71%), African-American (12.9%), Asian (2%), and Latino (2%.) Ninety percent had no prior medical conditions, and 978 (66%) were taking no prescription medicines. Thirty athletes were taking medications (including Adderall) for attention deficit hyperactivity disorder.
Two athletes had undergone ablation procedures in the past, both for symptomatic accessory
Discussion
In a 5-year experience, we demonstrated that adding ECGs to an athletic screening program discovers significant pathology in Division I college athletes at a cost per significant cardiac finding that is similar to that of history and physical alone. Although adding ECG to history and physical did increase the cost, the yield increased proportionately. Thus, the overall program cost per diagnosis was similar to the cost per diagnosis for history and physical or ECG screening alone. This
Conclusion
ECG screening of elite collegiate athletes increased the cost of screening due to false-positive ECGs but identified 8 cardiac abnormalities, 6 of which required intervention and 2 of which required discontinuation of athletic participation. The cost per diagnosis suggested by history and physical alone was similar to the cost per diagnosis identified by ECG.
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