Abstract 11390: The Personal and Family History Questions in the AHA Cardiovascular Screen for Athletes and the Screening ECG
Background: The American Heart Association (AHA) guidelines regarding the preparticipation evaluation (PPE) of competitive athletes recommend screening with 12-elements which consists of 8 questions from the personal and family history and 4 findings from the physical exam. Current recommendations state a positive response in any of the 12 elements can trigger a referral for cardiovascular evaluation. Addition of the screening ECG to the PPE has been avoided given concern for unnecessary testing and consultation. This study examines the false-positive rate when combining the AHA medical history questions with the screening ECG in a group of athletes free of any adverse cardiovascular event.
Methods: From 2010-2013, 297 (167 male) high school athletes, 1,016 (541 male) collegiate athletes, and 283 professional male athletes answered the AHA medical history questions. ECGs were obtained for all participants and interpreted using the Seattle criteria and European Society of Cardiology (ESC) recommendations.
Results: Approximately one-quarter of all athletes (23.8%) had at least one positive response to the AHA personal and family history questions. 6.0% had an abnormal ECG based on Seattle criteria and 26.8% had an abnormal ECG based on ESC recommendations. If a positive response to any of the AHA medical history questions and an abnormal ECG were required for further testing, then 1.4% of participants would have been referred for further testing using the Seattle criteria and 6.1% would have been referred using the ESC recommendations.
Conclusions: Screening athletes for cardiovascular risk using the AHA 12-elements alone results in an unacceptably high rate of false-positives (23.8%). In this study population without any adverse cardiac events, the rate of false-positives can be lowered, without increasing the number of false-negatives, to a more acceptable level if having an abnormal ECG was required along with having a positive response to the AHA 12-elements.
Author Disclosures: T. Dunn: None. S. Aggarwal: None. D. Pickham: None. D. Sani: None. N. Kumar: None. V. Froelicher: Ownership Interest; Modest; co-owner Cardea, manufacturer of ECG screening devices and software?.
- © 2014 by American Heart Association, Inc.