The Cardiovascular PPE

One of the more popular articles in our November 2015 CJSM has been “Limitations of Current AHA Guidelines and Proposal of New Guidelines for the Preparticipation Examination of Athletes,” from a group of authors who are in the Division of Cardiovascular Medicine at Stanford University.  This is also one of the studies that have been picked by the Editor-in-chief to be freely available, and so if you click on that link you can read not just the abstract, but the study itself.

The authors set out “To examine the prevalence of athletes who screen positive with the preparticipation examination guidelines from the American Heart Association, the AHA 12-elements, in combination with 3 screening electrocardiogram (ECG) criteria.”  

The topic of screening to prevent sudden cardiac death (SCD) in athletes, in particular young athletes, is a perennial ‘hot button’ issue in our field — we’ve written about the issue here in the blog, and we have published several studies on the subject in the journal.  As most readers of the blog will know, in the USA (in contradistinction to Europe, Japan, Israel and elsewhere), there  is no recommendation for inclusion of an ECG in PPE screening.

There are many interesting aspects to the Stanford study.  The main outcome measures in the screen of 1596 high school and college athletes were i) the 8 personal and family history questions from the AHA 12-elements; and ii) ECGs using three separate criteria for interpretation: Seattle criteria, Stanford criteria, and European Society of Cardiology (ESC) criteria.  The different criteria had different rates of abnormal ECGs, but what was most concerning was the nearly 25% of athletes who screened ‘positive’ using AHA questions.

The authors conclude, “In a patient population without any adverse cardiovascular events, the currently recommended AHA 12-elements have an unacceptably high rate of false positives. Newer screening guidelines are needed, with fewer false positives and evidence-based updates.”

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