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Cardiovascular screening in athletes has been a source of controversy within the sports medicine community. Annual screening inclusive of ECG is currently required by all major professional sports leagues in the USA and recommended by the IOC.1 In 2016, the American Medical Society for Sports Medicine (AMSSM) published a statement on cardiovascular screening, recognising knowledge gaps and advocating for medical providers caring for competitive athletes to consider important factors when determining an individualised cardiovascular screening strategy. These include the risk of sudden cardiac arrest (SCA) in the specific athlete population, the available resources and cardiology infrastructure for screening and secondary evaluations.2
The purpose of this investigation was to determine the cardiovascular screening practices of the US National Governing Bodies (NGBs) and National Paralympic Committees (NPCs). This study was approved by the Institutional Review Board from the Hospital of Special Surgery. Medical team members for the US NGBs and NPCs were identified through internet queries, affiliation with the AMSSM and professional contacts. From April through November 2015, an online survey was distributed to identified medical team members regarding the cardiovascular screening practices of their respective NGBs or NPCs.
Medical team members for 49 of 72 US Olympic-level or Paralympic-level teams (68.1%) were identified and contacted; 42/49 (85.7%) completed the assessment (34/39 from NGBs and 8/10 from NPCs). Twenty-one teams (50.0%) reported that there was a periodic health evaluation (PHE) mandate that directed the cardiovascular screening components, frequency and/or provider. The following screening components were reported as being performed at least once in all or most athletes: 38 teams (90.5%) personal history, 36 (85.7%) family history, 34 (81.0%) physical exam, 14 (33.3%) ECG, 2 (4.8%) echocardiogram and 1 (2.4%) stress test (table 1).
When measured in combination, the majority of teams screened all or most athletes at least once with personal history, family history and physical exam (33 teams, 78.6%). Most teams (31 teams, 73.8%) performed cardiovascular screening annually with at least one screening component. For teams who did not screen athletes with ECG, the most frequently cited reasons were lack of ECG equipment (40%), lack of evidence (33%), lack of consensus for ECG criteria and secondary testing (33%), expense of performing ECG screening and secondary testing (20%) and lack of physicians to interpret ECGs (7%). Limitations of this study were the self-report study design and inability to identify medical team members from all the US NGBs and particularly NPCs. Thus, results may not be applicable to NGBs and NPCs not represented in the study.
Medical team members at every level of sports should assess the differential risk of SCA in the athletes under their care and implement cardiovascular screening programme that reflect the SCA risk of the athletes and available resources and infrastructure. The incidence of SCA in Olympic-level and Paralympic-level athletes is unknown but would be expected to vary based on athlete demographics and sport risk factors as it does in other contexts, such as in collegiate sports.3 Once a screening strategy has been defined, it should be consistently performed throughout a NGB or NPC and routinely reassessed.
In summary, the US NGBs and NPCs have varying approaches to cardiovascular screening which may reflect the heterogeneous characteristics of the teams, sports and medical resources. Infrastructure limitations, which include lack of ECG equipment and lack of physicians to interpret the ECG, were cited by nearly half of teams to be a barrier to implementing advanced screening protocols. New international standards for ECG interpretation and recommendations for secondary testing of ECG abnormalities may address other concerns regarding the use of ECG in the screening protocol.4 The results of this study should inform the US NGBs and NPCs in their efforts to ensure that all Olympic-level and Paralympic-level athletes receive appropriate cardiac screening protocols as part of the PHE.
Contributors BGT: concept, design, acquisition, analysis, interpretation, drafting, revising, final approval. CC: design, interpretation, revising, final approval. JC: acquisition, analysis. IMA: design, interpretation, revising, final approval.
Competing interests None declared.
Ethics approval Hospital for Special Surgery.
Provenance and peer review Not commissioned; externally peer reviewed.
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