Abstract 16969: Diagnostic Yield and Financial Implications of Nationwide Screening for Cardiac Disease in Young Individuals
Introduction: Cardiovascular evaluation of young individuals outside competitive sport in most western countries is normally reserved for those with symptoms or family history suggestive of cardiac disease. However, the diagnostic yield of such a strategy is not known.
Aim: To investigate the diagnostic yield and report the workload and financial implications of a nationwide ECG screening program in young individuals.
Methods: Between 2011-2014, 26,909 young individuals (14-35 years) underwent screening by a cardiologist with a health questionnaire and physical examination (H+P), and ECG interpreted with the 2010 European Society of Cardiology recommendations. Individuals with positive results were referred to their local hospitals for further investigations with costs based on the UK national health service tariffs. Prospective follow-up was conducted via a primary care physician questionnaire.
Results: The mean age of the cohort was 19.7(±4) years. The majority were male (65%) and Caucasian (93%). 852 (3.2%) were considered to have an abnormal H+P according to the screening cardiologist whilst 1,482 (5.5%) had an abnormal ECG. After a follow-up of 32 (±10) months, 8.1% required echocardiography, 1.5% exercise stress test, 1.6% Holter, 1% cardiac MRI and 0.3% other tests. 66 (0.3%) were diagnosed with serious cardiac disease [H+P n=7 (11%); ECG n=59 (89%)]. The overall cost per individual screened amounted to $98. The cost per diagnosis of serious cardiac disease equated to $111,456 for screening with H+P alone and $40,356 for screening with ECG.
Conclusions: This large nationwide study suggests that the current practice of reserving cardiac evaluation exclusively for young individuals with symptoms or positive family history is counter-intuitive given the lower diagnostic yield and paradoxically near 3-fold increase in cost per serious cardiac diagnosis compared to screening inclusive of ECG.
Author Disclosures: H. Dhutia: Other Research Support; Modest; research grant from Cardiac Risk in the Young. A. Malhotra: Other Research Support; Modest; research grant from Cardiac Risk in the Young. G. Finocchiaro: Other Research Support; Modest; research grant from Cardiac Risk in the Young. M. Papadakis: None. M. Tome: None. S. sharma: Consultant/Advisory Board; Modest; advisory cardiologist for Cardiac Risk in the Young.
- © 2016 by American Heart Association, Inc.