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Cardiac screening for athletes
29 Feb2008
Tennessee heart test credited with saving lives
Tennessee is one of only a few universities that routinely perform echocardiograms on all athletes. A fan last year volunteered to provide the screenings at no cost.
The expense of such a test — between $500 and $1,500 for each athlete — is why some universities do not offer it to all athletes, said Dr. Douglas Zipes, the past president of the American College of Cardiology and a distinguished professor of medicine at Indiana University.
Cardiologists and other heart experts say that the screenings could help save the lives of the 125 American athletes younger than 35 who die each year of sudden cardiac death. Most show no symptoms of heart disease until it becomes fatal.
An analysis of 387 cases from the Minneapolis Heart Institute Foundation, which tracks sudden deaths in a national registry, showed the vast majority were cardiac-related. About a quarter involved hypertrophic cardiomyopathy, which causes an enlarged heart.
If one did a careful cost-effectiveness analysis, the results may argue against routine echocardiograms. On the other hand, cost-effectiveness analysis always has problems when death is involved. The problem in cost-effectiveness analysis is that we have to place a monetary value on life. What is that value? I would argue that the lives of adolescents and young adults have enough value to make these studies cost-effective.
Zipes said athletic officials often think echocardiograms were not worth the cost because they caught so few cases of heart disease. theirs is also a chance of false readings — falsely identifying a case of cardiomyopathy or missing signs of the condition.
Still, heart experts in Italy, where athletes are required to have an echocardiogram before competing, say the tests have led to a tenfold reduction in sudden deaths.
“If it were my son playing ball, I would like him to have an echo, even though it is cost inefficient,†Zipes said.
I believe that one could easily do a cost effectiveness analysis and demonstrate that this test does make sense.
I previously wrote about this 5 years ago – When athletes die young
I hope that the NCAA with its television millions will develop a plan to extend the Tennessee plan to other institutions.
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- In: Medical Rants
2 Responses to Cardiac screening for athletes
Dr Wes
March 3rd, 2008 at 11:29 am
Rob –
Having kids, I can honestly say I’d never want them to die because they participated in risky activities, especially if they had a “discoverable” condition. That is speaking as a parent.
But as form of policy to disseminate to the general public, echocardiograms are inherently expensive, require careful standards on which to base reading evaluations (and not all labs are accredited nor do they all have qualified techs), and like any test, are subject to false positives, especially when applied to a population with a low incidence of disease. The cost to our healthcare system, especially in today’s climate, is excessive, especially when we need to consider the public’s interest. Additionally, many of those proposing these tests are the very ones most likely to gain financially from such a policy.
So as a cardiologist and parent, I’d love it if such a policy were enacted. But as a matter of public policy, I’m not sure it’s cost effective, whatever that means.
kim
April 3rd, 2008 at 8:43 pm
As a parent whose son just open heart surgery 3wks. ago after discovering a RCA (rt. coronary anomaly) due to a routine echo, I am a proponent. This echo saved my son’s life. He appeared to be a healthy 13yr. To be exact he had 1 1/2 left in his basketball season. I was having him evaluated for ATP a clotting disorder because he dad just died in November 2007 after being sick for 2mos. A murmur was heard by his pediatrician, who recommended a visit to a ped cardiologist. Thinking this was just a precautionary measure, I never thought we would discover something so deadly. my son was a walking time-bomb. We did not even know it. After his surgery we were told that it was worse than suspected, if we had waited any longer he would be dead. So yes, I feel it should be a part of public policy. We are richest nation in the world and healthcare is so down on our lists of priorities it is sad. Especially since we are a nation of sport lovers. Even if we save 50 athletes that is 50 lives. I feel this should be mandated in the middle school athletics especially since this is when many young people become active in sports. my son has been an athlete since he was three and this was just discovered.