Key result
Hybrid athlete cardiovascular screening balances safety, sustainability, and access over purely mandatory or voluntary models.
Why the study?
Sudden cardiac death in athletes remains a major clinical and public health concern, with uncertainty about optimal balance between safety, sustainability, and equitable access to cardiovascular screening.
Does cardiovascular screening prevent sudden cardiac death in competitive athletes?
Does cardiovascular screening prevent sudden cardiac death in competitive athletes?
A proposed hybrid, risk-based cardiovascular screening approach may balance the high efficacy of mandatory ECG screening with the lower resource burden of history-only models to sustainably reduce sudden cardiac death in athletes.
Supports hybrid athlete screening models; leaves open prospective trials to confirm mortality benefit and feasibility.
Sudden cardiac death (SCD) in athletes remains a major clinical and public health concern, raising complex questions regarding the optimal balance between safety, sustainability, and equitable access to cardiovascular screening. Two contrasting paradigms are currently adopted worldwide: the mandatory and standardized Italian model and the voluntary, history-based approach predominantly used in the United States. The Italian system, which includes routine electrocardiography and exercise testing, has been associated with a marked reduction in SCD incidence but is burdened by high costs, false-positive findings, and organizational challenges. Conversely, the United States model limits resource utilization but is associated with higher mortality rates and significant inequalities in access to preventive care. Using competitive basketball as a representative high-risk sport model, this narrative review summarizes the principal cardiac conditions associated with SCD. It discusses the strengths and limitations of existing screening strategies. We propose a hybrid, risk-based screening approach that integrates targeted diagnostic testing with continuous clinical surveillance, emergency preparedness, and structured education programs. Attention is given to the role of physiotherapists and allied health professionals as daily clinical observers within multidisciplinary teams. A multidimensional preventive strategy—combining selective screening, professional training, emergency action planning, and shared decision-making—may represent a sustainable and ethically sound model for further reducing SCD among athletes while preserving the right to sport.
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Palmiero et al. (2026) conducted a review in Sudden cardiac death. Cardiovascular screening vs. Voluntary screening (US model) was evaluated. A hybrid, risk-based cardiovascular screening approach for athletes may offer an optimal balance between safety, sustainability, and access, merging the benefits of mandatory Italian and voluntary US models.
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