Cardiac Screening

October 31, 2014

The American Heart Association has once again concluded that sophisticated and expensive heart screening is not practical or appropriate as a precondition for youth and young adults to participate in competitive organized sports.
On Sept. 14, 2014, the AHA online publication Circulation stated:

Sudden death among 12 to 25-year-olds is “a low event rate occurrence.”

“There is insufficient information to support the view that ECGs in asymptomatic young people for cardiac disease is appropriate or possible on a national basis for the United States, in competitive athletics or in the general population.”

“At present, there is no mechanism available in the United States to effectively create national programs of such magnitude, whether limited to athletics or including the wider population of all young people.”

“There is insufficient evidence that particularly large-scale/mass screening initiatives are feasible or cost effective within the current US healthcare infrastructure . . .”

“The ECG . . . cannot be regarded as an ideal or effective test when applied to large healthy populations.”

“An additional, but unresolved, ethical issue concerns whether students who voluntarily engage in competitive athletic programs should have advantage of cardiovascular screening, while others who choose not to be involved in such activities (but may be at the same or similar risk) are in effect excluded from the same opportunity.”

The AHA’s Sept. 14 AHA writing group “does not believe the available data support significant public health benefit from using the 12-lead ECG as a universal screening tool. The writing group, however, does endorse the widespread dissemination of automated external defibrillators which are effective in saving young lives on the athletic field and elsewhere.”

A Can-Do Response

January 5, 2015

Michigan has a tradition of some of the nation’s most lenient out-of-season coaching rules, especially in the summer; and yet, the few rules we have are sometimes blamed for driving students to non-school programs.
Nevertheless, there is some validity to the criticism. It is observably true that non-school programs seem to fill every void in the interscholastic calendar. The day after high school seasons end, many non-school programs begin. The day a school coach can no longer work with more than three or four students, a non-school coach begins to do so.
The challenge is to balance the negative effects of an “arms war” in high school sports against driving students toward non-school programs. It’s the balance of too few vs. too many rules out of season.
The out-of-the-box compromise for this dilemma could be to not regulate the off season as much as to conduct school-sponsored off-season programs in a healthier way than they normally occur, i.e., to move schools back in control of and in the center of the non-school season. To not merely regulate what schools and coaches can’t do, but actually run the programs they can do and want to do.
Of course, this would require more of what schools have less of – resources. School administrators who may be in agreement that schools should operate off-season programs to keep kids attached to in-season programs still balk because they lack resources. At a time when resources are being cut for basic support of in-season programs, how could they justify spending more for out-of-season outreach?
Ultimately, in discovering the sweet spot for out-of-season interaction between school coaches with student-athletes, we need to give at least as much attention to providing more opportunity for what they can do together as for what they can’t do.