Abstract 10798: Sudden Cardiac Death Screening in the High School Athlete: A Statewide Evaluation of Compliance with the American Heart Association Guidelines
Background: The preparticipation physical evaluation (PPE) is the standard of care for annually screening 6-7 million high school athletes for their risk of sudden cardiac death (SCD) at an estimated cost of $250 million/year.
Purpose: Our aim was to evaluate primary care provider compliance with the American Heart Association (AHA) consensus statement on SCD screening.
Methods: The Washington Chapter of the American Academy of Pediatrics (AAP) and the Washington Association of Family Physicians (WAFP) were provided a 36 question survey. Responses were evaluated for compliance with individual elements of the AHA guidelines, as well as by a score of overall compliance. In addition, every Washington State high school athletic director was surveyed to determine their school's compliance with the AHA guidelines.
Results: We received an excellent response rate (72% (559/776) from the AAP, 56% (554/990) from the WAFP, and 75% (317/424) from the athletic directors). Only 5.7% of all providers and 0% of schools were in complete compliance with the AHA guidelines. Less than half (47%) of the providers and 6% of athletic directors were aware of the AHA guidelines. Notably, 28% of providers don’t always ask about exertional chest pain, 22% don’t always ask about syncope, and 26% don’t always ask about family history of premature death. There was no difference in overall compliance between provider types (p-value 0.20). Provider location, years of experience, and exposure to SCD were not significantly associated with overall compliance. Provider knowledge of the guidelines, level of satisfaction with the PPE, number of PPE/month, and number of referrals to cardiology were all positively associated with improved overall compliance (p-value <0.05).
Conclusion: Less than 6% of primary care providers are in full compliance with national PPE guidelines, which have remained unchanged for 15 years. This lack of compliance does not reflect clinical experience, practice location, or provider type, but rather a lack of knowledge of the guidelines themselves. New directions for provider education and policy requirements are needed to improve this implementation gap.
- © 2011 by American Heart Association, Inc.