Is cardiovascular screening in athletes justified? Inconsistent messages from the American Heart Association.

Recent reports from the American Heart Association (AHA) and by lead authors of the 2014 AHA guidelines for cardiovascular screening in athletes present many inconsistencies that need to be critically examined. In three different AHA statements (1996, 2007, 2014), the AHA has endorsed cardiovascular screening: “Both AHA and ESC consensus panels have agreed previously that screening to detect cardiovascular abnormalities in asymptomatic young competitive athletes is justifiable in principle on ethical, legal, and medical grounds.” Furthermore, the AHA has not endorsed cardiovascular screening for young non-athletes: “Consideration for large-scale, general population, and universal cardiovascular screening in the age group 12 to 25 years with history-taking and physical examination alone is not recommended (including on a national basis in the United States) (Class III, no evidence of benefit; Level of Evidence C).” However, <1 year from publication, the AHA and leaders of the 2014 guidelines have called into question the very ethics of screening only young athletes, and recommended that all young persons be screened, with a cardiac history and physical examination as part of an expanded public health policy —two points in direct contradiction to recommendations in the 2014 AHA guideline.