European Heart Journal Advance Access originally published online on June 17, 2005
European Heart Journal 2005 26(17):1804; doi:10.1093/eurheartj/ehi379
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Cardiovascular pre-participation screening of young competitive athletes for prevention of sudden death: proposal for a common European protocol
Department of Paediatric Cardiology
Freeman Hospital
Freeman Road
High Heaton
Newcastle NE7 7DN
UK
Tel: +44 191 284 3111
E-mail address: christopher.wren{at}tfh.nuth.northy.nhs.uk
I read with great interest the article ‘Cardiovascular pre-participation screening of young competitive athletes for prevention of sudden death: proposal for a common European protocol’ by Corrado et al.1 The consensus statement of the ESC working groups is a welcome attempt to highlight the problem of sudden death related to sporting activities in young people.1 However, as a set of guidelines, it is disappointing because it fails to define ‘pre-participation’, ‘young’, or ‘competitive’. Sudden death can occur at any age, and it is likely that the risk from some of the diagnoses considered in the report (such as long QT syndrome) is higher in childhood than in adult life. In most, or perhaps all, European countries, children are expected to take part in sports and games at school as part of their normal curriculum and one would expect those activities to be competitive.
If the working groups recommend ‘systematic pre-participation cardiovascular screening of young competitive athletes for the timely detection of cardiovascular abnormalities pre-disposing to sport-related cardiac death,’ they need to be more specific. Are they recommending screening of the whole population? This has been considered in the past but is thought to be impractical.2 At what age should such screening be undertaken? What evidence is there that if such screening is undertaken at a young age it will not produce false-negative results which would later be positive?
The report also fails to take sufficient account of the economic and logistic impact of such a policy. It is not simply a question of stopping all those who fail the screening test from taking part in activity. They would all expect to be referred for an expert cardiological assessment. For instance, presumably 2.5% of the population would be found to have a QT interval >2 SD above the mean and would require further assessment.
The recommendations need to be more specific and need to be backed up by evidence that screening is effective. As Law said in a recent editorial, ‘Pubic Health Authorities should not advocate screening of unproved value. Giving information to people considering screening ... when the only honest information is complete uncertainty is useless. Encouraging people to decide for themselves is ducking the issue.’3
References
- Corrado D, Pelliccia A, Bjornstad HH, Vanhees L, Biffi A, Borjesson M, Panhuyzen-Goedkoop N, Deligiannis A, Solberg E, Dugmore D, Mellwig KP, Assanelli D, Delise P, van-Buuren F, Anastasakis A, Heidbuchel H, Hoffmann E, Fagard R, Priori SG, Basso C, Arbustini E, Blomstrom-Lundqvist C, McKenna WJ, Thiene G. Cardiovascular pre-participation screening of young competitive athletes for prevention of sudden death: proposal for a common European protocol. Eur Heart J 2005;26:516–524.
[Abstract/Free Full Text] - Maron BJ. How should we screen competitive athletes for cardiovascular disease? Eur Heart J 2005;26:428–430.
[Free Full Text] - Law M. Screening without evidence of efficacy. BMJ 2004;328:301–302.
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