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.”

Health & Safety Journey

September 30, 2014

The Michigan High school Athletic Association is a bit more than halfway through an eight-year effort to shine the light on, and provide leadership for, four health and safety issues for school sports.
Four and five years ago our health and safety focus was adding more health history to the preparticipation physical examination process and printed forms. With the essential assistance of the Michigan Department of Community Health, this was done, and it earned widespread, positive reaction from Michigan’s diverse medical community.
Two and three years ago our focus was the head; and our early adoption of an all-sports return-to-play protocol after concussion symptoms became a national model.
Last year and this, heat and hydration has been the focus. The MHSAA imposed on its own tournaments, and recommended for member schools’ practices and contests, policies to manage heat and humidity that include a reduction or modification of activities when the heat index reaches a certain level and cessation of all activities when the heat index reaches an even higher level.
Next school year and in 2016-17 the focus will be the fourth “H”: hearts. Tests for heart defects are expensive and results are often misleading, and the triggers of sudden cardiac arrest are unpredictable. Therefore, we will be pointing to the two actions medical authorities appear to agree upon most: (1) the need for planned and practiced emergency procedures, and (2) the need to have AEDs nearby, in good working order.
We urge MHSAA member schools not to wait for the MHSAA focus to make this a local school focus, and we recommend the MI HEARTSafe Schools initiative. See the HeartSafe Action Plan or the HeartSafe School information for details.