PT  - JOURNAL ARTICLE
AU  - Ghani, Saqib
AU  - Papadakis, Michael
AU  - Kemp, Simon
AU  - Zaidi, Abbas
AU  - Sheikh, Nabeel
AU  - Gati, Sabiha
AU  - Raju, Hariharan
AU  - Smith, Andy
AU  - Palmer, Corin
AU  - Somauroo, John
AU  - Sharma, Sanjay
TI  - Results of a nationally implemented de novo cardiac screening programme in elite rugby players in England
AID  - 10.1136/bjsports-2015-095902
DP  - 2016 Nov 01
TA  - British Journal of Sports Medicine
PG  - 1338--1344
VI  - 50
IP  - 21
4099  - http://bjsm.bmj.com/content/50/21/1338.short
4100  - http://bjsm.bmj.com/content/50/21/1338.full
SO  - Br J Sports Med2016 Nov 01; 50
AB  - 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.