February 28, 2026Journal of the American College of Cardiology1 citations
View Full PaperCardiac Screening for Conditions Associated With Sudden Cardiac Death
Key Result
A single cardiac screening in young individuals identified conditions associated with sudden cardiac death in 0.3% of participants, with a subsequent event incidence of 5.6 per 100,000 person-years.
Key Points
- To assess the diagnostic yield of cardiac screening and the incidence of sudden cardiac death in young populations.
- Conducted screening for 104,369 individuals aged 14 to 35 years from 2008 to 2018.
- Utilized questionnaires, electrocardiograms, and selective echocardiography for evaluations.
- Followed individuals for a mean duration of 6.0 years to track subsequent diagnoses of cardiac conditions.
- Identified 280 individuals (0.3%) with conditions linked to sudden cardiac arrest/sudden cardiac death during screening.
- Post-screening, 86 (0.08%) individuals were diagnosed with issues related to sudden cardiac death or experienced sudden cardiac events.
- Incidence rate of sudden cardiac arrest/sudden cardiac death was 5.6 per 100,000 person-years.
Study Design
Type
Cohort (n=104,369)
Structured PICO
Does a single cardiac screening with questionnaire, ECG, and selective echocardiography identify conditions associated with sudden cardiac death and prevent sudden cardiac arrest in young individuals aged 14 to 35 years?
P
Population
104,369 consecutive individuals aged 14 to 35 years (62% male, 89% White, 9% athletes) from the young general population.
I
Intervention
Single screening with a questionnaire, electrocardiogram (ECG), and selective echocardiography, followed by consultation with an attending cardiologist.
O
Outcome
Diagnostic yield of cardiac screening, subsequent cardiac diagnoses after initial clearance, and incidence of sudden cardiac arrest (SCA) and sudden cardiac death (SCD) over a mean follow-up of 6.0 ± 2.5 years.hard clinical
A single cardiac screening in young individuals identified conditions associated with sudden cardiac death in 0.3% of participants, but subsequent events still occurred at a rate of 5.6 per 100,000 person-years, suggesting serial evaluations may be needed to address age-related penetrance.
Limitations
- Age-related penetrance may limit the effectiveness of a single screening
Abstract
BACKGROUND Efforts to prevent sudden cardiac death (SCD), including cardiac screening, have focused on young athletes. There is limited data on the impact of population screening for conditions associated with SCD in the young general population. OBJECTIVES The objective of this study was to determine the diagnostic yield of cardiac screening, subsequent cardiac diagnoses after initial clearance, and incidence of sudden cardiac arrest (SCA) and SCD in young individuals after a single screening. METHODS Between 2008 and 2018, 104,369 consecutive individuals aged 14 to 35 years (62% male, 89% White, 9% athletes) underwent a single screening with a questionnaire, electrocardiogram (ECG), and selective echocardiography. All individuals had a consultation with an attending cardiologist who reviewed the results and recommended secondary cardiac evaluation when appropriate. Outcomes were obtained from national databases and a follow-up questionnaire. RESULTS Of the 104,369 individuals screened, 2,619 (2.5%) were referred for secondary evaluation, 937 (0.9%) because of symptoms or family history of clinical concern, 1,361 (1.3%) because of an abnormal ECG, and 321 (0.3%) because of both. Screening identified 280 (0.3%) individuals with conditions associated with SCA/SCD, of whom 115 (41%) received risk-modifying interventions, including 10 prophylactic implantable cardioverter defibrillators and 2 cardiac transplants. Over a mean follow-up of 6.0 ± 2.5 years, 86 (0.08%) additional individuals were diagnosed with conditions associated with SCA/SCD, including 35 who experienced SCA (n = 15) or SCD (n = 20). The incidence of SCA/SCD was 5.6 of 100,000 person-years. Median age of presentation was 23.8 years (IQR: 10.5), and events occurred a median of 3.6 years (range: 0.2-11.7) after screening. The sensitivity of the ECG and the questionnaire for detecting conditions associated with SCA/SCD was 75.4% and 32.5%, respectively. CONCLUSIONS A single cardiac screening identified a condition associated with SCA/SCD in 0.3% of young individuals of whom 41% received risk-modifying interventions beyond lifestyle and medication. Over a 6-year follow-up, 0.08% of individuals cleared at screening were diagnosed with conditions associated with SCA/SCD or presented with SCA/SCD. The incidence of SCA/SCD was 5.6 of 100,000 person-years, underscoring the need to strengthen strategies for the prevention of SCD in young individuals. Serial evaluations may mitigate the challenge of age-related penetrance.
Expert Takes1 quote
“Although initial baseline screening provides diagnostic value, the subsequent incidence of sudden cardiac events in previously cleared individuals indicates that serial evaluations are necessary to overcome the challenge of age-related penetrance.”
ACC Journal ScanView source
Cite This Study
MacLachlan et al. (Sun,) conducted a cohort in Conditions associated with sudden cardiac death (n=104,369). Single cardiac screening (questionnaire, ECG, selective echocardiography) was evaluated on Diagnostic yield of cardiac screening, subsequent cardiac diagnoses, and incidence of sudden cardiac arrest and death. A single cardiac screening in young individuals identified conditions associated with sudden cardiac death in 0.3% of participants, with a subsequent event incidence of 5.6 per 100,000 person-years.