Cardiac screening in the young for the detection of cardiovascular disease and prevention of sudden cardiac death

Q: What is the clinical evidence from this study?

Study design: Review. Population: Inherited cardiovascular disease and sudden cardiac death in the young. Intervention: Cardiac screening (health questionnaire, 12-lead ECG, selective echocardiography, and AI-enabled ECG) vs. No screening or health questionnaire without ECG.

Daniel T. Tardo; Sanjay Sharma

doi:10.1371/journal.pmed.1005278

October 22, 2026PLoS MedicineOpen Access

Cardiac screening in the young for the detection of cardiovascular disease and prevention of sudden cardiac death

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Key result

ECG-based cardiac screening detects sudden cardiac death-associated conditions in ~0.3% of young individuals.

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Why the study?

Does structured cardiac screening (incorporating 12-lead ECG and AI-enabled technologies) improve the detection of inherited cardiovascular disease and prevent sudden cardiac death in young athletic and non-athletic individuals?

Key Points

To evaluate the clinical justification, international frameworks, and emerging artificial intelligence technologies for proactive cardiac screening to prevent sudden cardiac death in young individuals.
Reviewed global cardiac screening legislation, observational cohorts, and population registries across Italy, Denmark, Japan, and the United Kingdom.
Analyzed screening cohort data from the UK Cardiac Risk in the Young programme comprising N=104,369 individuals aged 14–35 screened between 2008 and 2018 using questionnaires, 12-lead electrocardiography, and selective echocardiography.
In the UK cohort of 104,369 individuals, 2.5% (n=2,619) were referred after initial evaluation, with 280 (0.27%) diagnosed with an SCA/SCD-associated condition and 41% receiving risk-modifying interventions.
The 12-lead electrocardiogram demonstrated a sensitivity of 75.4% for detecting SCA/SCD-associated conditions compared to 32.5% for health questionnaires, with 0.08% (n=86) of cleared individuals diagnosed during follow-up.
Observational outcomes showed an almost 90% decline in sudden cardiac death among screened Italian athletes over 25 years, while repeat evaluations in children increased diagnostic yield by 60%.

Structured PICO

Does structured cardiac screening (incorporating 12-lead ECG and AI-enabled technologies) improve the detection of inherited cardiovascular disease and prevent sudden cardiac death in young athletic and non-athletic individuals?

P

Population

Young athletic and non-athletic individuals under 35 years of age undergoing cardiac screening for inherited cardiac conditions and prevention of sudden cardiac death.

I

Intervention

Cardiac screening combining a focussed health questionnaire (symptoms and family history), physical examination, 12-lead electrocardiogram (ECG) including AI-enabled ECG (AI-ECG), and selective echocardiography

O

Outcome

Detection of sudden cardiac arrest (SCA) / sudden cardiac death (SCD)-associated inherited and congenital cardiac conditions, and prevention of SCDhard clinical

Structured cardiac screening in the young using 12-lead ECG governed by international criteria—and potentially enhanced by AI-ECG—effectively detects silent inherited cardiac conditions and supports public health policies aimed at preventing sudden cardiac death.

Limitations

Evidence addressing whether cardiac screening reduces sudden cardiac death is predominantly observational in the absence of randomized trials
ECG interpretation depends on expertise and is prone to false positives and significant inter-observer variability
False negatives occur in concealed channelopathies, cardiomyopathies, and age-related penetrance when only a single evaluation is performed
AI-ECG models are not yet validated in young cohorts and face challenges with low event rates, inherited vs. acquired substrates, and athletic ECG adaptations
Evidence addressing whether screening reduces SCD is predominantly observational in the absence of randomised trials
ECG interpretation depends on expertise and is prone to false positives with significant inter-observer variability
False negatives occur in concealed channelopathies, cardiomyopathies, and age-related penetrance
Applying AI-ECG models to the young is limited by the rarity of SCA/SCD events, inherited rather than acquired disease substrates, and potential confounding by physiological athletic adaptation
Sex, gender, ethnicity differences, cost-effectiveness, and screening access/uptake remain underexplored

Implication

Observational data support ECG screening yield in the young; leaves open randomized confirmation of sudden cardiac death prevention.

Abstract

Sudden cardiac death in the young is often due to silent inherited cardiac conditions. Although evidence increasingly supports cardiac screening as a preventative strategy, policies and frameworks differ globally. Structured screening frameworks that utilise AI-enabled technologies show great potential for enhancing disease detection and risk prediction.

Discussion

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Cite This Study

Tardo et al. (2026) conducted a review in Inherited cardiovascular disease and sudden cardiac death in the young. Cardiac screening (health questionnaire, 12-lead ECG, selective echocardiography, and AI-enabled ECG) vs. No screening or health questionnaire without ECG was evaluated. Cardiac screening using 12-lead ECG and international interpretation criteria detects sudden cardiac death-associated conditions in 0.27% of young individuals with 75.4% ECG sensitivity.

synapsesocial.com/papers/6adb45ebfa57c0e8502b9476 https://doi.org/10.1371/journal.pmed.1005278

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Cardiac screening in the young for the detection of cardiovascular disease and prevention of sudden cardiac death

Figures

Key Points

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

Cardiac screening in the young for the detection of cardiovascular disease and prevention of sudden cardiac death

Figures

Key Points

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

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