Cardiovascular pre-participation screening of young competitive athletes for prevention of sudden death: proposal for a common European protocol

In May 2005, Corrado et al.1 published a consensus statement of the ESC working groups recommending pre-participation screening of all young, competitive athletes with the aim of preventing SCD. Screening was recommended to follow the Italian model, which includes 12-lead ECG, with screening commencing at age 12–14 and continuing every 2 years until age 35. The recommendation was based on findings that in the Veneto region in Italy, SCD from HCM among screened athletes was less frequent than expected. A task force appointed by the Danish Society of Cardiology has evaluated the available data and concluded that pre-participation screening should not be recommended in Denmark.2 The task force is of the opinion that ESC recommendations have not dealt adequately with a number of issues of pertinence, as adopted by the WHO when planning a screening programme. These issues include the following. Research on the effectiveness of pre-participation screening is very limited and relies heavily on Italian studies. The current research data neither supports nor refutes screening. A considerable number of healthy athletes will have abnormal ECGs or echocardiograms, which do not quite reach diagnostic criteria for cardiomyopathy (false positive). In addition to exclusion from organized sports, which may have considerable impact on the athletes' quality of life, abnormal findings would be likely to have implications for employment and life insurance. The screening programme does not identify the majority of athletes at risk of SCD (false negative). Although SCD caused by HCM in screened athletes was rare, the screening programme did not prevent SCD caused by other conditions, including ARVC, anomalous coronary arteries, and atherosclerosis.3 The economic impact and cost-effectiveness of such a policy should be analysed. The Italian data suggest that ∼10% of the entire population should be screened and that ∼9% of the screened athletes need further examinations, mostly involving echocardiography. For most countries, this would imply that the capacity for echocardiography should be significantly increased. The Danish task force recommends that registration of SCD in the young be improved so that the circumstances around these tragic deaths can be analysed with the aim of reducing the incidence. Possible preventive measures include better awareness among athletes and coaches of symptoms of structural heart disease that may precede SCD, better knowledge of resuscitation in the general population and in the sports environment in particular, better availability of defibrillators at relevant sites, and sensible precautions such as avoidance of strenuous exercise during mild infections, avoidance of dehydration, and so on. We would warmly welcome a further discussion of the proposed policy.