Implementing Cardiac Testing to Mitigate the Risk of Sudden Cardiac Death: An Evidence-to-Practice Review

In the United States, sudden cardiac death (SCD) is the leading cause of fatality in young athletes during exercise. Allied healthcare professionals have used screening tools such as the 12-Element American Heart Association recommendations, the European Society of Cardiology (ESC) recommendations, and the International Olympic Committee guidelines to screen for cardiovascular abnormalities in athletes. Although each of these protocols consist of personal and family history questions complemented with a physical examination, a uniform screening strategy to identify athletes at risk of SCD does not exist. The purpose of this evidence to practice review is to summarize a systematic review regarding SCD-related abnormalities in young Middle Eastern and African competitive athletes and to assess available cardiac preparticipation physical examination (PPE) screening tools. The authors examined literature that reported the prevalence of positive cardiac abnormalities detected with history and physical examination tools compared to noninvasive cardiac testing, such as electrocardiography. The review also highlights the significant number of false positives achieved through history and physical examination tools only, whereas electrocardiography interpretations indicated by the 2014 Refined Criteria are superior to the 2013 Seattle Criteria and the 2010 ESC Recommendations. The guiding systematic review indicates that electrocardiography is sensitive and specific to predicting SCD-related abnormalities and should be a tool implemented in the PPE.