Cardiovascular Preparticipation Screening of Competitive Athletes: A Statement for Health Professionals

The recommendations from this committee were as follows: "The American Heart Association recommends that some form of preparticipation cardiovascular screening for high school and collegiate athletes is justifiable and compelling, based on ethical, legal, and medical grounds. Consequently, we conclude that a complete and careful personal and family history and physical examination designed to identify (or raise suspicion of) those cardiovascular lesions known to cause sudden death or disease progression in young athletes is the best available, most practical approach to screening populations of competitive sports participants, regardless of age. Such cardiovascular screening is an attainable objective, and should be mandatory for all athletes. We recommend that both a history and physical examination be performed before participation in organized high school (grades 9 through 12) and collegiate sports. Screening should then be repeated every two years. In intervening years, an interim history should be obtained. Because of the heterogeneity in the design and content of preparticipation examinations, we also recommend developing a national standard for preparticipation medical evaluations. We also recommend that athletic screening be performed by a health care worker with the requisite training, medical skills, and background to reliably obtain a detailed cardiovascular history, perform a physical examination, and recognize heart disease." "Specifically, athletic screening evaluations should include a complete medical history and physical examination, including brachial artery blood pressure measurement." The article also suggests that when cardiovascular abnormalities are identified or suspected, the athlete should be referred to a cardiovascular specialist for further evaluation. Commentary: This American Heart Association Scientific Statement should be applauded. This statement looked at all the available data and came to some very practical important recommendations, which I personally support. The authors have looked at a number of important screening modalities such as the history, physical examination, echocardiography, electrocardiography, and Holter monitoring. It is clear that perhaps the single most important thing a physician can do is get a detailed medical history. This is the most cost-effective approach. There is very definite concern that widespread use of noninvasive testing such as echocardiography in athletic populations could result in many false-positive tests, creating unnecessary anxiety among substantial numbers of athletes and their families, as well as unjustified exclusion from life insurance coverage and athletic competition. Indeed, in such a situation with such a low incidence of disease in the community of sports athletes, a likely possibility would be that the number of false-positive results could even exceed that of true positives. It is also clear, however, that the history and physical examination done on athletes has not been standardized and that there needs to be a national standardized process applied to these examinations. The authors also correctly conclude that their guidelines should not "promulgate a false sense of security on the part of medical practitioners or the general public, because the standard history and physical examination intrinsically lack the capability to reliably identify many potentially lethal cardiovascular abnormalities. Indeed, it is an unrealistic expectation that large scale standard athletic screening can reliably exclude most important cardiac lesions." -DSM