Systematic echocardiography alongside ECG for athlete screening identified no additional cases of hypertrophic cardiomyopathy in isolation, whereas an ECG-led protocol reduced total costs by 47%.
Observational (n=1,628)
Does systematic echocardiography alongside ECG improve the identification of sudden cardiac death disease and cost-effectiveness in athletes undergoing pre-participation screening?
Systematic echocardiography during pre-participation screening in athletes does not increase the diagnostic yield for sudden cardiac death-associated diseases over an ECG-led approach and significantly increases costs.
BACKGROUND: The clinical and economic value of including systematic echocardiography (ECHO) alongside the 12-lead electrocardiograpm (ECG) when undertaking pre-participation screening in athletes has not been examined, yet several sporting organistations recommend its inclusion. DESIGN: To examine the efficacy of systematic ECHO alongside the ECG, to identify sudden cardiac death (SCD) disease and to provide a cost-analysis of a government-funded pre-participation screening programme. METHODS: A total 1628 athletes presented for cardiological consultation, ECG, and ECHO as standard, with further cardiac examinations performed if necessary to confirm or exclude pathology. The efficacy of systematic ECHO was compared to an ECG-led programme, with ECHO reserved as a follow-up examination. RESULTS: To screen 1628 athletes with ECG and ECHO cost US743, 996. There were 54 24-h-blood pressure/ECG Holter recordings, 62 exercise tests, 25 CMRs, two electrophysiological studies, and two genetic tests, which cost US67, 734: total US811, 730. Eight athletes (0. 5%) were identified with hypertrophic cardiomyopathy (HCM) and two (0. 1%) with Wolff-Parkinson-White syndrome. The cost per identifed athlete was US81, 173. All 10 athletes presented an abnormal ECG. No athlete diagnosed with HCM was identified by ECHO in isolation. When adopting a ECG-led screening protocol, 15% of athletes required ECHO as a follow-up examination, resulting in a US380, 600 cost reduction (47% saving), with the cost per diagnosis reduced to US43, 113. CONCLUSIONS: Athletes diagnosed with a disease associated with SCD were identified via an abnormal ECG and/or physical examination, personal symptoms, or family history. Screening athletes with systematic ECHO is not economically or clinically effective.
Riding et al. (Fri,) conducted a observational in Pre-participation screening in athletes (n=1,628). Systematic echocardiography (ECHO) alongside ECG vs. ECG-led programme (ECHO reserved as follow-up) was evaluated on Identification of sudden cardiac death (SCD) disease and cost per diagnosis. Systematic echocardiography alongside ECG for athlete screening identified no additional cases of hypertrophic cardiomyopathy in isolation, whereas an ECG-led protocol reduced total costs by 47%.