Friday, October 14, 2011

Mandatory Electrocardiographic Screening of Athletes to Reduce Their Risk for Sudden Death. Proven Fact or Wishful Thinking?

A little off-topic, but interesting nonetheless.
Because of their tragic nature, the media-at-large often emphasizes reports of young athletes dying of sudden cardiac arrest (the heart stops) during a practice or a game.  To address this obvious problem, many community groups and even some medical organizations have called for mandatory screening of young athletes for the kinds of electrical heart problems that may lead to a sudden arrest. A few of these programs sprung up in the early and mid-80s in Italy, Israel, and Minnesota USA. Well, the pendulum is beginning to swing the other way, and doctors are questioning the cost/benefit of screening all young athletes. That is the focus of this article.
A recent analysis of Italy's (The world's Ultimate Nannystate) ECG screening program, which ran for 25 years, showed a significant reduction in sudden cardiac death (SCD) during the program period. These authors questioned that result since, by comparison, SCD rates in Italy were high to start out with. A similar program was enacted in Israel in 1986, and the authors retrospectively analyzed the yearly standardized rates of SCD in competitive athletes from 1986-2006 to see if the screening program had an impact.
It did not.
In addition, a similar analysis of the Minnesota program showed the same result. Moreover, the authors concluded that even if one were to take the results of the Italian study as fact, it would cost around $1,500,000 in screenings and additional tests to save one life.Finally, because of the extrememly low incidence of SCD and the less-than-perfect specificity of the ECG, many many more healthy athletes would be excluded from participating because of palse positives than lives would be saved.
I'm not saying that morally one can put a price on human life, but since governments are often amoral they can, and they do.
Draw your own conclusion on how much a random young life is worth to the taxpayer.
-Nick

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