pre-participation sports evaluations are a hot topic – despite the growing data in support of testing we still have not collectively agreed on the best way to screen young people. many are familiar with the italian experience of screening all young athletes with electrocardiograms – this practice has diagnosed hypertrophic cardiomyopathy and other conditions and likely has prevented many deaths. but a limitation of screening many people for less common conditions is that some people without underlying heart conditions may have abnormal electrocardiograms leading to more expensive testing. and given limited resources we unfortunately must consider both benefit and cost. some have argued that sudden death from undiagnosed cardiac conditions is so uncommon that we frankly can’t afford to screen everyone. but recent research may suggest that screening with electrocardiograms may be cost-effective according to commonly accepted thresholds. one of my good friends from cardiology fellowship euan ashley who heads the stanford hypertrophic cardiomyopathy center recently published an article which directly addresses the question of whether screening athletes with electrocardiograms in addition to a medical history and physical exam is cost-effective as compared to a history and physical alone. cost-effectiveness is typically judged in terms of cost per life-year saved. euan and his team found that adding electrocardiograms to a screening program saved approximately 2. 1 life-years per 1000 people tested at an additional cost of about $89 dollars per athlete. this suggests a cost-effectiveness ratio of about $43 000 per life-year saved. in general procedures are felt to be cost-effective if they cost less than $50 000 per life-year saved. to give some perspective hemodialysis for end-stage kidney disease has a ratio that falls in the range of approximately $50 000. scientific data can guide us but it doesn’t help balance our budgets. while we might find that a given procedure treatment or screening test may be cost-effective by standard definitions that still doesn’t mean that we have the money to do it. and it is unlikely that we will stop paying for previously accepted procedures in favor of others that may be cheaper. electrocardiograms and kidney dialysis are apples and oranges. but the data does raise questions moving forward. given limited resources who should be entitled to potentially life-saving cardiac screening? the nfl nba and increasingly mls have access to some of the best medical care around. it is my hope that if we get our act together with regards to screening our professional athletes appropriately than perhaps we can focus the conversation on our sons and daughters who i would love to see screened on a more consistent basis in the future.
should young athletes be screened for heart conditions?