Cardiovascular Screening in the U.S. Military: Time to Reconsider the Electrocardiogram

INTRODUCTION: The US Department of Defense (DoD) has adopted a model concept of the warrior athlete. Identifying latent disease that could compromise the military operator is critical to the warrior athlete concept. Cardiovascular complaints are the important problem recognized in service members evacuated from combat zones, and the incidence of sudden cardiac death in U.S. military recruits is comparable to or greater than that among National Collegiate Athletic Association Athletes. Nevertheless, the mandatory electrocardiogram (ECG) was removed from official U.S. military accession screening policy in 2002. Inclusion of ECG screening in high risk athletics is increasingly recognized as appropriate by professional organizations such as the American Heart Association and American Medical Society for Sports Medicine, though neither recommends ECG for generalized screening in large, low-risk populations. MATERIALS AND METHODS: The appropriate DoD instructions were reviewed in the context of recent literature regarding the sensitivity and specificity of ECG screening for prevention of sudden cardiac arrest or debilitating arrhythmias. RESULTS: Challenges to implementation of ECG as a screening modality in U.S. military accessions include clinician interpretation validity and reliability. Modern interpretation criteria and new interpretation technology each serve to mitigate these recognized limitations. Outside experience with implementation of modern ECG suggest potential benefits are significant in the highest risk military groups. CONCLUSION: Prospective study of ECG screening is needed to determine the impact on cardiovascular outcomes in U.S. military populations.