Cost Implications of Using Different ECG Criteria for Screening Young Athletes in the United Kingdom
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Key result
Refined ECG criteria reduce abnormal ECGs ~80% versus 2010 ESC recommendations, lowering screening costs.
- 80% reduction
- P<0.0001
- n=4,925
Why the study?
High false-positive rates and subsequent investigation costs hinder ECG screening in young athletes, but actual costs had never been assessed systematically in a large cohort.
Does the use of contemporary ECG interpretation criteria (Seattle and refined) reduce the cost of pre-participation cardiovascular screening in young athletes compared to the 2010 ESC recommendations?
Population
A large cohort of young athletes
Comparison
2010 ESC criteria vs Seattle criteria vs refined ECG interpretation criteria
Authors
Discussion
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Key expert perspectives
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“This was the first study of comprehensive cardiovascular screening of young individuals outside competitive sport.”
SCSteven CoxCEO, Cardiac Risk in the Young
“There have been many challenges when the NSC has done their consultation process, in essence, they don't believe the ECG is a powerful tool, and say that screening does more harm than good because of false positives.”
“After people have an ECG that picks up a minor abnormality, they are referred to their GP and later referred to me. This process takes months and people spend this time terrified, avoiding things that are good for their health, like sports, when in the end it turns out you aren't at high risk of sudden cardiac death.”
Implication
May reduce false positives and costs in athlete ECG screening; leaves open need for prospective outcome validation before practice change.
Key Points
- To evaluate the financial implications of ECG interpretation in young athletes by comparing the 2010 European Society of Cardiology recommendations with contemporary Seattle and refined criteria.
- Evaluated cardiovascular screening outcomes using health questionnaires, physical examinations, and 12-lead ECGs in 4,925 athletes aged 14–35 years in the United Kingdom.
- Assessed referral rates for secondary investigations—including echocardiography, exercise stress testing, Holter monitoring, and cardiac MRI—under 2010 ESC recommendations, Seattle criteria, and refined criteria.
- Abnormal ECGs occurred in 1,072 (21.8%) athletes under 2010 ESC recommendations, falling to 295 (6.0%) with Seattle criteria and 210 (4.3%) with refined criteria (p<0.0001 for both vs. ESC).
- Potentially serious cardiac disease implicated in sudden cardiac death was confirmed in 15 (0.3%) athletes, and all 15 were identified regardless of the ECG criterion applied.
- The overall cost of screening was $110 per athlete with 2010 ESC recommendations, which decreased to $92 with Seattle criteria and $87 with refined criteria, representing a 21% cost saving per athlete (p<0.0001).
Study Design
Type
Cross-Sectional (n=4,925)
Multicenter
No
Structured PICO
Does the use of contemporary ECG interpretation criteria (Seattle and refined) reduce the cost of pre-participation cardiovascular screening in young athletes compared to the 2010 ESC recommendations?
P
Population
4,925 previously unscreened young athletes aged 14-35 years underwent cardiovascular screening to evaluate the cost implications of different ECG interpretation criteria.
E
Exposure
ECG interpretation using the Seattle and refined criteria (applied retrospectively).
C
Comparator
ECG interpretation using the 2010 European Society of Cardiology (ESC) recommendations (applied prospectively).
O
Outcome
Overall cost of de-novo screening, cost per athlete screened, and cost per serious diagnosis.
Main Result
Effect estimate: 80% reduction
Absolute Event Rate: 4.3% vs 21.8%
Absolute Risk Reduction: 17.5%
p-value: p=<0.0001
The application of contemporary ECG interpretation criteria (Seattle and refined) significantly reduces the false-positive rate and subsequent costs of pre-participation screening in young athletes without compromising the detection of serious cardiac disease.
Limitations
- Retrospective application of the Seattle and refined ECG criteria to the cohort
- Cost analysis is based on UK National Health Service tariffs, which may not be generalizable to other healthcare systems
- Cohort was predominantly male (83%) and white (85%)
Cite This Study
Dhutia et al. (2016) conducted a cross-sectional in Pre-participation cardiac screening (n=4,925). Refined and Seattle ECG interpretation criteria vs. 2010 European Society of Cardiology (ESC) recommendations was evaluated on Proportion of athletes with an abnormal ECG (80% reduction, p=<0.0001). Application of the refined ECG criteria reduced the rate of abnormal ECGs to 4.3% compared to 21.8% with the 2010 ESC recommendations, representing a 21% cost saving per athlete screened.
Topics
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