Controversies relating to preparticipation cardiovascular screening in young athletes: time for a realistic solution?

1 of 2 Papadakis M, Chandra N, Sharma S. Br J Sports Med (2010). doi:10.1136/bjsm.2009.067652 screening of athletes. Indeed, screening of athletes in the UK is confi ned to elite sporting organisations such as the Premier League football association and the Lawn Tennis Association that mandate independently fi nanced screening programmes in all youth athletes. In the USA and Italy, preparticipation cardiac screening programmes are in existence to minimise the risk of sudden death due to cardiac disorders in young athletes.4 The US programme utilises a health questionnaire relating to cardiac symptoms and a family history of premature cardiac disease, as well as physical examination of the cardiovascular system. Unfortunately, the reputation of such basic screening programmes has been jeopardised by American physicians holding international expert status in sports cardiology studies that have emphatically demonstrated an extremely poor yield in identifying athletes with fatal disorders.5 In Italy, a state-sponsored screening programme has been in place since the late 1970s and includes a health questionnaire, a cardiovascular physical examination and a 12-lead electrocardiography (ECG). The Italian experience from Veneto has shown that screening with ECG has reduced the death rate in athletes from 4.19/100 000 person-years to 0.43/100 000 person-years, equating to a reduction of approximately 90%.6 The data have received immense publicity and are considered the criterion standard paradigm for low cost and effective cardiac screening in young athletes. The impact of the number of life years saved is laudable and would be considered a health service boost if similar number of life years were preserved in individuals in the fi fth decade onwards. The reduction in these deaths was associated with a 7% of individuals requiring further investigations because of false-positive test results and the disqualifi cation of 2% of all athletes screened predominantly because of hypertension, cardiac conduction tissue Controversies relating to preparticipation cardiovascular screening in young athletes: time for a realistic solution? M Papadakis,1,2 N Chandra,1,2 S Sharma1,2