Abstract 17483: Healthy Heart Check®: A Large Scale Low-Cost Student Athlete Screening Model Using ECGs and Quick Look Echos Improve Specificity of ECG Screening of Student Athletes
Introduction: Exertion-related sudden cardiac death (SCD) in a student athlete is a catastrophic and potentially preventable event. Aggressive screening with ECGs may reduce SCD risk, but low specificity and perceived costs limit widespread utilization.
Purpose: We developed a rapid, low-cost, scalable cardiovascular screening model using physician volunteers and paid technical staff to effectively screen large numbers of high school students for SCD risk.
Methods: Physicians review a parent-completed cardiac risk questionnaire, perform a physical exam and analyze a 12-lead ECG. If higher risk is suspected, a quick-look 2D echo screens for structural disease. Students at increased risk are told to stop exercise and see their physician.
Results: Since 2007, 4 hospitals performed 23 free screenings at 12 locations, and screened 5,861 students (age 15.5 ± 1.9 yrs). Average screening time was 10 ± 4 min/student. Abnormal ECGs were found in 740 students (13%), of whom 467 were referred on for a quick look echo. Of these, 418 (90%) were normal. Abnormal echoes were seen in 49 students resulting in a “stop exercise” advisory for 10, or physician follow-up for 35. Of those with normal ECGs, 701 had echoes - 42 (94%) were normal. In the total population, 40 students (0.7%) received “stop exercise” and 527 (9%) physician follow-up advice. Findings included: HCM (1); dilated CM (2); significant LVH (2) and RVH (2); long QT (2); abnormal valve function (4); exertional or frequent syncope (3); tachy- or bradycardias (7); WPW (5); bundle branch block (4); immediate family history SCD (3); possible Marfan's Syndrome (1) and, pericardial effusion (1). Cost analysis of the screening, including staffing and supplies, was $7.84/student. The screening was successfully franchised to three new hospital groups.
Conclusions: In conclusion, our screening model provides a low-cost, accessible and sustainable physician-directed option for pre-participation cardiovascular examinations. Addition of a quick look echo reduces false positives generated by ECG screening by 90%. This volunteer-based screening is effective identifying high school students who may be at risk for SCD and other cardiovascular complications. The franchise kit is offered free of charge to other communities.
- © 2011 by American Heart Association, Inc.