Outcomes of a nationwide cardiac screening programme in young females

Abstract Introduction There is limited data on the efficacy of cardiac screening for detecting conditions associated with sudden cardiac arrest (SCA) and sudden cardiac death (SCD) in young individuals, and especially in females, outside the context of competitive athletes. Purpose We aimed to determine the diagnostic yield of a nationwide cardiac screening programme, subsequent cardiac diagnoses after initial clearance and the incidence of SCA and SCD amongst in young females aged between 14 to 35 years. Methods Between 2008 to 2018, 39,661 consecutive females (95% non-athletes, 97% white) underwent a single evaluation as part of a voluntary cardiac screening programme. The evaluation consisted of a health questionnaire, 12-lead ECG and selective echocardiography. All individuals had a consultation with an attending cardiologist who reviewed the results and recommended secondary cardiac evaluation when appropriate. Clinical outcomes were obtained via the Office of National Statistics-Hospital Episode Statistics database, an online questionnaire and direct feedback to the screening provider. Results Screening resulted in 1,056 females (2.7%) being referred for further evaluation. Of those referred, 175 (0.44%) were diagnosed with a cardiac condition, including 94 (0.23%) with a disorder associated with SCD. The most prevalent SCD-associated condition was Wolff-Parkinson-White syndrome (n = 49), followed by cardiomyopathies (n = 21) and inherited primary arrhythmia syndromes (n = 20). During a mean follow-up period of 6.0 + 2.5 years, an additional 92 (0.23%) females were diagnosed with a cardiac condition, of which 28 (0.07%) were identified with a condition associated with SCD. During the follow-up period, 2 females experienced SCA, one due to arrhythmogenic right ventricular cardiomyopathy and one due to Brugada syndrome. Four individuals experienced SCD, 3 cases were attributed to sudden arrhythmic death syndrome in individuals who had been cleared at screening and one was attributed to long QT syndrome, diagnosed at the time of screening but experienced SCD prior to secondary cardiac evaluation. The incidence of SCA/SCD was 2.3/100,000 person-years. Conclusions A single cardiac screening identified a condition associated with SCA/SCD in 0.23% of young females, which represents 9% of females flagged by screening and referred for further evaluation. Over a 6-year follow-up, 0.07% of individuals cleared at screening were diagnosed with conditions associated with SCA/SCD or presented with SCA/SCD. The incidence of SCA/SCD was 2.3/100,000 person-years, underscoring the need to strengthen strategies for the prevention of SCD in young females. Serial evaluations may mitigate the challenge of age-related penetrance, suggesting a role for integrating repeat screening in the future.Female outcomes of cardiac screeningFor image description, please refer to the figure legend and surrounding text. Cardiac diagnoses in femalesFor image description, please refer to the figure legend and surrounding text.