Key result
Adding FoCUS to standard screening increases sensitivity for detecting SCD-associated conditions to ~94%.
Why the study?
Pre-participation screening modalities for preventing sudden cardiac death in athletes are debated due to high false-positive rates, and the cost-effectiveness of FoCUS remains uncertain.
Does the addition of focused cardiac ultrasound (FoCUS) to standard pre-participation screening improve diagnostic accuracy and cost-effectiveness for detecting conditions associated with sudden cardiac death in athletes?
Observational (n=2,111)
Does the addition of focused cardiac ultrasound (FoCUS) to standard pre-participation screening improve diagnostic accuracy and cost-effectiveness for detecting conditions associated with sudden cardiac death in athletes?
Absolute Event Rate: 94% vs 58%
Incorporating focused cardiac ultrasound into pre-participation screening for athletes significantly improves the detection of conditions associated with sudden cardiac death in a cost-effective manner.
Supports FoCUS addition to athlete screening for higher sensitivity; hypothesis-generating and should not yet change practice.
AIMS: The role of pre-participation screening (PPS) modalities in preventing sudden cardiac death (SCD) in athletes is debated due to a high false-positive rate. Focused cardiac ultrasound (FoCUS) has shown higher sensitivity and specificity, but its cost-effectiveness remains uncertain. This study aimed to determine the diagnostic performance and cost-effectiveness of FoCUS use in PPS. METHODS AND RESULTS: A total of 2111 athletes (77.4% male, mean age 24.9 ± 15.2years) underwent standardized family and medical history collection, physical examination, resting electrocardiography (ECG), FoCUS (10 min/5 views protocol), comprehensive echocardiography and exercise stress test. We prospectively evaluated three PPS incremental models: Model A, standardized medical history and physical examination Model B, Model A plus resting and stress ECG and Model C, Model B plus FoCUS (10 min/5 views protocol). We determined their incremental diagnostic accuracy and cost-effectiveness ratio. A total of 30 athletes were diagnosed with a cardiac condition associated with SCD: 3 were identified by Model A, 14 by Model B, and 13 athletes by Model C. The introduction of FoCUS markedly increased the sensitivity of PPS, compared with Model A and Model B (sensitivity 94% vs. 19% vs. 58% specificity 93% vs. 93% vs. 92%). The total screening costs were as follows: Model A 35.64 euros, Model B 87.68 euros, and Model C 120.89 euros. Considering the sole conditions at risk of SCD, the incremental cost-effectiveness ratio was 135.62 euros for Model B and 114.31 for Model C. CONCLUSIONS: The implementation of FoCUS into the PPS allows to identify a significantly greater number of athletes at risk of SCD and markedly lowers the false negative rate. Furthermore, the incorporation of FoCUS into the screening process has shown to be cost-effective.
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Hálasz et al. (2023) conducted an observational in Athletes undergoing pre-participation screening (n=2,111). Focused cardiac ultrasound (FoCUS) vs. Standardized medical history, physical examination, and resting/stress ECG was evaluated on Sensitivity for detecting cardiac conditions associated with sudden cardiac death. Adding focused cardiac ultrasound (FoCUS) to standard pre-participation screening increased sensitivity for detecting conditions at risk of sudden cardiac death from 58% to 94% and was cost-effective.
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