Cardiac screening for athletes
I wrote a column a couple of years ago about the rare but headline-grabbing occurrence of sudden death in young, competitive athletes. The experts I spoke to for that article agreed that, despite how tragic it is, there’s not much point in demanding that everyone who wants to compete in a sport gets an electrocardiogram to check for cardiac abnormalities.
The new issue of BMJ has a debate on precisely that issue. Two Italian researchers argue in favour, on the basis of a 25-year study of compulsory screening in a region of Italy that reduced deaths from 3.6 to 0.4 per 100,000 athlete years, mostly due to the detection of hypertrophic cardiomyopathy (a thickening of the heart muscle). The estimated cost: $42,000 per life-year saved.
A Norwegian researcher takes the opposite position, pointing out the high rate of false positives and the fact that populations like Norway actually have very low rates of hypertrophic cardiomyopathy compared to Italy. He makes the following estimates: Norway, with a population of 4.9 million, has about three exercise-related deaths per year among young (15-34) people, of which which just one is related to a condition that could be detected by ECG screening. The population at risk (i.e. that would be subject to screening) is about 325,000 people. Previous studies have found a 10% false positive rate, so 36,000 people would need further follow-up, like an echocardiogram or cardiac MRI. Ultimately, he agrees with the 2007 guidelines published by the American Heart Association, which concluded that whole-population screening would be a bad idea.
One aspect missing from the discussion, as far as I could tell, is the full extent of the toll such a program would take on all the kids disqualified from taking part in sport. I’d like to know how many there were in that Italian region (it’s not given in the BMJ article, though it’s possible I might be able to find it by digging through the references cited). Without even taking quality of life into account, how many “life-years” are lost by those who’ve been forced to live a sedentary life?