Athletic Directors and Doctors Want Standard SCD Screening

Reed Miller

November 13, 2011

November 13, 2011 (Orlando, Florida) — High school athletic directors in one state, at least, are clamoring for a common, professional-guidelines compliant protocol for screening young athletes for sudden cardiac death (SCD) risk, instead of the hodgepodge of noncompliant forms they use now.

At the American Heart Association (AHA) 2011 Scientific Sessions, Dr Nicolas Madsen (University of Washington, Seattle) presented the results of a survey of 1113 pediatricians and 317 high school athletic directors in Washington State showing that most of them support the institution of a common, guidelines-driven form that doctors can follow during a preparticipation physical evaluation (PPE) to make sure the exam follows the guidelines.

The survey found that fewer than 6% of doctors fully follow the national guidelines for assessing the risk of SCD during a high school PPE. Only 45% to 50% of doctors were aware of the relevant guidelines for high school PPE--which haven't changed since 1996--and only 5.7% of athletic directors knew of them.

Not a single high school in the entire state of Washington was completely following the American Heart Association guidelines for PPE that were reaffirmed in 2007, Madsen said. In total, 55% of schools in the survey had a specific PPE form that doctors filled out for the exam, 44% of schools allowed exams by nonphysician practitioners, and 60% of schools used exam protocols that included only eight of the 12 elements of cardiovascular screening recognized by the guidelines. For example, about 75% of doctors asked teenagers about their history of cardiac symptoms, but only about a third asked if they had a relative with known heart disease.

The study found that doctors' compliance with the guidelines was statistically linked to their knowledge of the guidelines' existence. There was not an association between compliance rates and the doctors' location, experience, or subspecialty.

Although this survey was only carried out in one state, "this is unlikely to be an exclusively regional phenomenon. Physicians in Washington State are trained all across the country . . . and the physicians certainly recognize the problem," Madsen said at the AHA meeting. "The way forward is to develop a single statewide PPE form that is obviously necessary and well-supported."

Madsen and colleagues has shared their research with the Washington Interscholastic Activities Association, the governing body of high school sports in the state, and the group's executive board voted this summer to make the Preparticipation Physical Evaluation, 4th ed monograph from the American Academy of Pediatrics the standard form for the entire state.

Commenting on the study, Dr Clyde Yancy (Northwestern University, Chicago, IL) said that following the PPE guidelines is not as simple as it may appear. Talking to young athletes and their parents about the risk of sudden death is "a difficult conversation that must be organized around the patient's sensitivities," Yancy told reporters at the AHA conference. "Imagine the anxiety" of a young person learning they're at risk of sudden death. Many doctors find it "difficult to have a conversation that could result in telling [the young athlete], 'You can't do this.' "

The authors had no conflicts of interest to disclose.

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