Key result
Application of AHA/ACSM and 2001 Masters guidelines to older novice endurance athletes identified 42.1% and 75.2% as needing pre-participation evaluation, respectively, with modest completion rates.
Why the study?
What is the utility and yield of applying AHA/ACSM and 2001 Masters pre-participation cardiovascular screening guidelines to older novice endurance athletes?
Observational (n=1,457)
What is the utility and yield of applying AHA/ACSM and 2001 Masters pre-participation cardiovascular screening guidelines to older novice endurance athletes?
Current pre-participation cardiovascular screening guidelines flag a large proportion of older novice endurance athletes for testing, which may not be cost-effective given the rarity of cardiovascular events in this population.
Answers are grounded in this paper and cite their sources.
May flag many novice older athletes for evaluation; leaves open guideline validation in prospective studies.
OBJECTIVES: Despite robust growth in participation in marathons and endurance sports among older individuals, guidance regarding pre-participation cardiovascular evaluation of these athletes is lacking. The objective of this study was to assess the utility of currently available pre-participation cardiovascular evaluation guidelines as applied to a cohort of older novice endurance athletes. METHODS: We applied data from 1457 novice runners and endurance athletes aged 35 years and older to two pre-participation screening tools, the American Heart Association/American College of Sports Medicine Pre-Participation Questionnaire and the 2001 Working Group recommendations for pre-participation screening of masters athletes (2001 Masters). RESULTS: Application of the American Heart Association/American College of Sports Medicine Pre-Participation Questionnaire identified 42.1% for which pre-participation cardiovascular evaluation was indicated. Of those who met criteria, 51.5% reported completion of a healthcare evaluation. Application of the 2001 Masters guidelines identified 75.2% who qualified for pre-participation electrocardiogram and 34.0% for pre-participation stress testing. Of those who met 2001 Masters criteria for pre-participation testing, 43.7% and 24.6% underwent recommended electrocardiogram and stress testing, respectively. While there was modest concordance with recommendations for pre-participation evaluations based on both American Heart Association/American College of Sports Medicine Pre-Participation Questionnaire and 2001 Masters, only athlete age was independently associated with completion of a pre-participation healthcare evaluation and only athlete age and athlete's participation in marathons were independently associated with pre-participation stress testing. CONCLUSION: Among older novice endurance athletes, application of the American Heart Association/American College of Sports Medicine Pre-Participation Questionnaire and 2001 Masters guidelines identifies a significant percentage of athletes for whom pre-participation evaluation and testing are recommended. Concordance with these guidelines was modest and providers were primarily influenced by athlete age and competitive goals when planning pre-participation testing. Given the rarity of cardiovascular events among older participants in endurance events, the cost-effectiveness of the American Heart Association/American College of Sports Medicine Pre-Participation Questionnaire and 2001 Masters guidelines may be unacceptable for general use.
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Abbatemarco et al. (2016) conducted an observational in Novice runners and endurance athletes (n=1,457). Pre-participation cardiovascular screening guidelines (AHA/ACSM and 2001 Masters) was evaluated on Proportion of athletes qualifying for pre-participation cardiovascular evaluation and testing. Application of AHA/ACSM and 2001 Masters guidelines to older novice endurance athletes identified 42.1% and 75.2% as needing pre-participation evaluation, respectively, with modest completion rates.
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