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In 1996 the American
Heart Association published a scientific statement on screening for
cardiovascular abnormalities in young athletes
participating in organized sports programs in US high schools and
colleges. "Cardiovascular Preparticipation Screening
of Competitive Athletes" (Circulation. 1996;94:850–856)
served as a critique of current and past screening practices and
offered several specific recommendations for future screening
endeavors, including the content of history and physical examination
questionnaires, the nature and qualifications of designated examiners,
and the timing of preparticipation examinations. This statement has
become a well-known guideline endorsed by other medical and exercise
science organizations.
However, the recommendation for timing of preparticipation evaluations
has become the source of some discussion. In the original statement,
the writing group recommended that "both a history and a
physical examination be performed before participation in organized
... collegiate sports. Screening should then be repeated every 2
years. In intervening years an interim history should be
obtained."
In July 1997 the National Collegiate Athletic Association (NCAA)
Committee on Competitive Safeguards and Medical Aspects of Sports
expressed concern about this recommendation. First, the NCAA questioned
whether there were substantive scientific data to support the AHA
viewpoint. Second, a full preparticipation physical examination
routinely performed every 2 years is in fact not now a customary
practice for the majority of US colleges and universities. The NCAA
believed that, lacking medical evidence to support the recommendation,
such a change in protocol would place a considerable burden on the
annual screening process for the 300 000 NCAA athletes. The NCAA
argued that although some member institutions would probably be able to
comply (or in fact already do so) with the recommendation, most
colleges and universities would find it difficult in light of economic
restraints and the availability of facilities, personnel, and time.
Confronted with this argument, the writing group considered whether
there was any clear advantage to preparticipation screening for the
detection of important cardiovascular disease in
college-aged athletes every 2 years and concluded that the NCAA's
concerns were valid. The writing group determined that there was scant
scientific evidence to show definitively that a routine second
examination after 2 years of college competition would identify more
athletes with cardiovascular abnormalities (except
possibly those with systemic hypertension), given that the initial
evaluation was negative for cardiovascular disease.
Therefore, the writing group believes that it is prudent to
recognize the concerns raised by the NCAA. The writing group offers
this amendment to the original recommendation for timing of
preparticipation evaluations in collegiate athletes: For
collegiate athletes, the American Heart Association recommends that a
comprehensive personal and family history be obtained and that a
physical examination be performed by a qualified examiner in the first
year upon entering the institution and before beginning training and
competition. In each of the subsequent 3 to 4 years, an interim history
and a blood pressure measurement should be obtained. Important changes
in medical status or abnormalities detected during interim annual
histories may constitute evidence that another physical examination and
possible further testing should be performed.
Of note, the original AHA recommendations for preparticipation
screening of high school athletes at 2-year intervals remain
unchanged.
Footnotes
A single reprint is available by calling 800-242-8721 (US only) or writing the American Heart Association, Public Information, 7272 Greenville Avenue, Dallas, TX 75231-4596. Ask for reprint No. 71-0142. To purchase additional reprints: up to 999 copies, call 800-611-6083 (US only) or fax 413-665-2671; 1000 or more copies, call 214-706-1466, fax 214-691-6342, or E-mail pubauth@amhrt.org. To make photocopies for personal or educational use, call the Copyright Clearance Center, 508-750-8400.
© 1998 American Heart Association, Inc.
AHA Scientific Statement
Cardiovascular Preparticipation Screening of Competitive Athletes: Addendum
An Addendum to a Statement for Health Professionals From the Sudden Death Committee (Council on Clinical Cardiology) and the Congenital Cardiac Defects Committee (Council on Cardiovascular Disease in the Young), American Heart Association
Key Words: AHA Medical/Scientific Statements • exercise • sudden death
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