We hear the stories more and more often about the deaths of
high school athletes after collapsing on their respective playing fields. People
are often shocked at the cause of those deaths: sudden cardiac arrest. However, that cause of death is a lot more common than people think.
According to the National Center for Catastrophic Sport
Injury Research, there are around 12 deaths of high school and college athletes
nationwide every year. The leading cause of those deaths is sudden cardiac
arrest. The Centers for Disease Control and Prevention also state that about
2,000 people under the age of 25 will die from sudden cardiac arrest every
year. If those deaths seems so sudden, can a simple electrocardiogram screening help prevent these deaths?
Well, it turns out that it is a lot more complicating, and
there are opposing views on the practice. Some doctors believe that it should
be more commonplace when athletes are getting their physicals done. The NCAA
even considered requiring EKG screenings, but both the American Heart
Association and the American College of Cardiology oppose wide-scale screenings.
An electrocardiogram, or EKG, monitors the electrical
activity of the heart, but it generates a significant amount of false positives
and false negatives. There is also a problem with reading EKGs correctly.
Furthermore, an athlete’s heart tends to develop differently than a non-athlete’s,
which could change the electrical activity and imply that there is a problem
when there really isn’t. EKGs can then lead to further and sometimes unnecessary testing. Instead, the American Heart Association and the American College of Cardiology suggests a 14-point questionnaire that asks about symptoms and family health histories as an alternative.
So what should be done? Should mandatory screenings be implemented? Or should physicians rely on a questionnaire and then make decisions based on the responses?
More information can be found with this link: http://www.cnn.com/2015/10/23/health/preventing-football-deaths/
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ReplyDeleteIt sounds to me that the questionnaire focusing on family health history seems like a more reliable way to help prevent sudden cardiac arrest than the EKGs. It is possible that an athlete could suffer sudden cardiac arrest with no or little family history of cardiac problems, but the chance is probably less than that of reading an EKG falsely. Bringing awareness to athletes and coaches is also important because many do not know that this could happen. Knowledge could give people that are at risk the opportunity to take preventative measures and coaches the opportunity to know how to respond if the event ever occurred. Awareness is spreading and this is reflected in actions such as the Sudden Cardiac Arrest Prevention Act by TN Department of Health. The details can be seen at the link posted below.
ReplyDeletehttp://sciaa.digitalsports.com/2015/11/12/sudden-cardiac-arrest-prevention-act/
Although this topic is definitely notable and has a profound impact on mindsets regarding healthcare and sports, it really only accounts for a fraction of deaths in individuals under the age of 21. According to the American Heart Association (AHA), the following statistics represent the cause of death for individuals under 21 years of age in the US: Accident~14000, Homicide~4200, Suicide~2500, Neoplasm~2500, Cardiac Disease~2200, SCD~100-150. As tragic and notable as SCD is, due to the national attention that these deaths normally recieve, does it warrant additional healthcare time and expenditure in EKG testing when it impacts such a small population? Every life truly is precious and SCD deaths may be prevented by appropriate testing if results are appropriately read by hightly trained cardiologists or seasoned sports physicians, but one could argue that the additional funds that may be needed for such additional testing/result reading may be better put to use to help reduce homicide and suicide rates that are considerably higher in this age group. However, one could argue that there is proof that mandatory EKG testing would reduce SCD death numbers, as Italy has required athletes to be tested for more than 25 years. Over this time, they report a reduction of SCD incidence from 3.6/100,000 person-years to 0.4/100,000 person years; a 90% reduction. A person years is defined as the sum of individual units of time that the persons in the study population have been exposed or at risk to the conditions of interest (medicallexicon.com). This statistic is considerable, but once again, in comparison to other pre-21 causes of death, it is minimal. All people who play sports are made aware of the risks that may follow, whether it be in footbal, basketball, soccer, baseball, etc. Each has their own risk and these risks are drastically less than say driving in a car (more than 11,000 pre-21 fatalities in 2007 alone). Death is an inevitable part of life and although methods of prevention should be attempted at all costs, these methods should be focused where they will have the most impact. Therefore, EKG testing should not be mandatory for young athletes.
ReplyDeleteAmerican Heart Academy
http://circ.ahajournals.org/content/125/20/2511.full
Journal of the American College of Cardiology
http://content.onlinejacc.org/article.aspx?articleid=1659758
National Highway Traffic Safety Administration
http://www-fars.nhtsa.dot.gov/Main/index.aspx
As a high school basketball coach, I would be 100% for getting my players checked out. The last thing in the world I would want to see is one of my players collapse on the court. One of my players is currently having heart palpitations and they are constantly monitoring him - all because of a bad break up with his girlfriend. The kids now are growing up in a much different world than the majority of us did. When one of us went through a break up, we just avoided them around school. Nowadays with everyone on 10 different forms of social media, you can't get away from it. Sudden cardiac arrest (SCA) is a prevalent and frightening thing that needs to be taken more seriously.
ReplyDeleteThe study I found showed that 95% parents have heard about SCA and 10% have been directly affected by it. Shockingly, 43% of the parents surveyed did not believe that SCA was anything to be concerned about. Anything that we can feasibly be doing to protect the lives of kids should be done. Although I understand that there are many risks that are more prevalent than SCA, if it may be able to be monitored or better prepared for from one EKG, there should not be a reason not opt for it. For underprivileged schools and children, this may not be the most realistic idea, but for those who can afford it, I cannot understand why the parents would not take this extra step.
Wagener, M. A. (2015, October). Parental Knowledge of Cardiovascular Screening and Prevention of Sudden Cardiac Arrest in Youth Athletes. In 2015 AAP National Conference and Exhibition. American Academy of Pediatrics.