Re: ECG Cost-Effective for Screening Student Athletes

[Guest guest]

I found this alos very interesting

Ralph Giarnella MD

Southington Ct USA

ECG Cost-Effective for Screening Student Athletes

By Crystal Phend, Senior Staff Writer, MedPage Today

Published: November 16, 2009

Reviewed by Dori F. Zaleznik, MD; Associate Clinical Professor of Medicine,

Harvard Medical School, Boston and

Dorothy Caputo, MA, RN, BC-ADM, CDE, Nurse Planner

Action Points

* Note that the American Heart Association and American College of

Cardiology guidelines suggest ECG as optional for preparticipation screening of

student athletes.

* Note that this study was published as an abstract and presented at a

conference. These data and conclusions should be considered preliminary until

published in a peer-reviewed journal.

ORLANDO -- Cost issues should no longer keep electrocardiograms out of most

schools' efforts to screen student athletes for potentially fatal heart

problems, researchers said here.

Recent declines in the price of ECG machines mean that students can be screened

for a cost of less than $3 each after an initial investment of under $500 per

school, according to a study led by DeBauche, MD, of Cypress Cardiology

in Cypress, Texas.

Addition of 12-lead ECG to screening would cost just $300 per year of life

saved, DeBauche's group reported at the American Heart Association meeting.

This price was so far below the typical cost-effectiveness threshold of $50,000

per life-year that there should no longer be any question about adopting ECG in

screening, DeBauche said.

His group set up a program to add a one-time ECG for every student participating

in competitive sports in their suburban Houston school district.

Although high school football is enormously popular in Texas where games can

draw tens of thousands of spectators, like most other states, Texas requires

only a perfunctory physical exam and completion of a questionnaire on possible

symptoms and family cardiac history for participation.

ECG is universally acknowledged as more likely to identify serious cardiac

problems, and it has been adopted as an international standard for screening in

much of the world.

One prior study from a region in Italy, which pioneered nationwide screening of

athletes with ECG in the late 1990s, revealed a 90% drop in sudden cardiac

events after the screening program began. (See National Screening Slows Sudden

Cardiac Deaths Among Athletes)

But ECG has not been advocated in national guidelines for the U.S. in large part

because of the cost, Zipes, MD, of Indiana University and a past

president of the American College of Cardiology, noted.

" The U.S. is behind the times when it comes to screening athletes, " he said,

calling current efforts in much of the country woefully inadequate.

Scattered U.S. programs have adopted ECG following the Italian model. " Everybody

agrees, yes, it should be done, but it's optional because we don't think we can

afford, on a national level, a mandated program, " DeBauche said.

At current reimbursement levels, sending all student athletes to the hospital or

a physician's office for an ECG at about $100 each would cost over an estimated

$1 billion, DeBauche said.

The program his group designed, though, would cost under $2 million to screen

all 200,000 U.S. athletes in the ninth grade, which is an optimal age to catch

problems -- before high school sports but after onset of puberty, he said.

The program included providing laptop-based ECG machines for each of 10 high

schools in the school district.

Athletic trainers and other school employees were trained to apply the ECG leads

according to a diagram, take the ECG with the push of a button, and forward the

HIPAA compliant electronic file to DeBauche's team for interpretation.

Of the 2,057 freshmen screened, 9% (186 students) had an abnormal ECG result and

were advised to set up a consultation, get a screening echocardiogram for

diagnosis, or both.

Only 0.6% had a serious enough abnormality to eliminate them from participation

in competitive sports.

Among the 173 who accepted further examination for their abnormal findings, the

diagnoses included:

* Eight cases of Wolff-Parkinson-White syndrome

* 23 cases of left ventricular hypertrophy

* Three cases of moderate severity mitral valve regurgitation

* Six cases of right ventricular pulmonary hypertension

* One case of cardiomyopathy

* 17 cases of mitral valve prolapse.

One student was found to have noncompaction cardiomyopathy, a clearly

life-threatening condition that subsequently led to implantation of a

defibrillator and waitlisting for a heart transplant.

A second case of aortic coartication and the right ventricular abnormalities

" certainly had major clinical significance, " the researchers said.

An echocardiogram to follow-up on abnormal cases could be carried out by

commercial screening firms specializing in large numbers of relatively easy

studies and reimbursed by all major insurers, DeBauche said.

The ECG itself would cost only $0.50 per ECG for electrodes and about $2.00 for

interpretation.

" When you find something this good you should do it, " DeBauche said.

Barry lin, PhD, of Beaumont Hospital in Royal Oak, Mich., agreed

that this type of screening wouldn't necessarily need a clinical cardiologist

since a nurse or other trained staff could administer the ECG.

" It's a very simple test, " he said.

The biggest costs involve setting up the infrastructure, Zipes added.

" We're talking about the lives of youngsters, " he said. " If that were your son

or daughter, you would want it done. "

[Guest guest]

I thought mitral valve prolapse was a common condition, that doesn't

disqualify an individual from sports.

Giovanni Ciriani - West Hartford, CT - USA

On Sun, Jan 10, 2010 at 11:37 AM, Ralph Giarnella <ragiarn@...> wrote:

>

>

> I found this alos very interesting

> Ralph Giarnella MD

> Southington Ct USA

>

> ECG Cost-Effective for Screening Student Athletes

> By Crystal Phend, Senior Staff Writer, MedPage Today

> Published: November 16, 2009

> Reviewed by Dori F. Zaleznik, MD; Associate Clinical Professor of Medicine,

> Harvard Medical School, Boston and

> Dorothy Caputo, MA, RN, BC-ADM, CDE, Nurse Planner

>

> Action Points

>

> * Note that the American Heart Association and American College of

> Cardiology guidelines suggest ECG as optional for preparticipation screening

> of student athletes.

>

> * Note that this study was published as an abstract and presented at a

> conference. These data and conclusions should be considered preliminary

> until published in a peer-reviewed journal.

>

> ORLANDO -- Cost issues should no longer keep electrocardiograms out of most

> schools' efforts to screen student athletes for potentially fatal heart

> problems, researchers said here.

>

> Recent declines in the price of ECG machines mean that students can be

> screened for a cost of less than $3 each after an initial investment of

> under $500 per school, according to a study led by DeBauche, MD, of

> Cypress Cardiology in Cypress, Texas.

>

> Addition of 12-lead ECG to screening would cost just $300 per year of life

> saved, DeBauche's group reported at the American Heart Association meeting.

>

> This price was so far below the typical cost-effectiveness threshold of

> $50,000 per life-year that there should no longer be any question about

> adopting ECG in screening, DeBauche said.

>

> His group set up a program to add a one-time ECG for every student

> participating in competitive sports in their suburban Houston school

> district.

>

> Although high school football is enormously popular in Texas where games

> can draw tens of thousands of spectators, like most other states, Texas

> requires only a perfunctory physical exam and completion of a questionnaire

> on possible symptoms and family cardiac history for participation.

>

> ECG is universally acknowledged as more likely to identify serious cardiac

> problems, and it has been adopted as an international standard for screening

> in much of the world.

>

> One prior study from a region in Italy, which pioneered nationwide

> screening of athletes with ECG in the late 1990s, revealed a 90% drop in

> sudden cardiac events after the screening program began. (See National

> Screening Slows Sudden Cardiac Deaths Among Athletes)

>

> But ECG has not been advocated in national guidelines for the U.S. in large

> part because of the cost, Zipes, MD, of Indiana University and a

> past president of the American College of Cardiology, noted.

>

> " The U.S. is behind the times when it comes to screening athletes, " he

> said, calling current efforts in much of the country woefully inadequate.

>

> Scattered U.S. programs have adopted ECG following the Italian model.

> " Everybody agrees, yes, it should be done, but it's optional because we

> don't think we can afford, on a national level, a mandated program, "

> DeBauche said.

>

> At current reimbursement levels, sending all student athletes to the

> hospital or a physician's office for an ECG at about $100 each would cost

> over an estimated $1 billion, DeBauche said.

>

> The program his group designed, though, would cost under $2 million to

> screen all 200,000 U.S. athletes in the ninth grade, which is an optimal age

> to catch problems -- before high school sports but after onset of puberty,

> he said.

>

> The program included providing laptop-based ECG machines for each of 10

> high schools in the school district.

>

> Athletic trainers and other school employees were trained to apply the ECG

> leads according to a diagram, take the ECG with the push of a button, and

> forward the HIPAA compliant electronic file to DeBauche's team for

> interpretation.

>

> Of the 2,057 freshmen screened, 9% (186 students) had an abnormal ECG

> result and were advised to set up a consultation, get a screening

> echocardiogram for diagnosis, or both.

>

> Only 0.6% had a serious enough abnormality to eliminate them from

> participation in competitive sports.

>

> Among the 173 who accepted further examination for their abnormal findings,

> the diagnoses included:

>

> * Eight cases of Wolff-Parkinson-White syndrome

> * 23 cases of left ventricular hypertrophy

> * Three cases of moderate severity mitral valve regurgitation

> * Six cases of right ventricular pulmonary hypertension

> * One case of cardiomyopathy

> * 17 cases of mitral valve prolapse.

>

> One student was found to have noncompaction cardiomyopathy, a clearly

> life-threatening condition that subsequently led to implantation of a

> defibrillator and waitlisting for a heart transplant.

>

> A second case of aortic coartication and the right ventricular

> abnormalities " certainly had major clinical significance, " the researchers

> said.

>

> An echocardiogram to follow-up on abnormal cases could be carried out by

> commercial screening firms specializing in large numbers of relatively easy

> studies and reimbursed by all major insurers, DeBauche said.

>

> The ECG itself would cost only $0.50 per ECG for electrodes and about $2.00

> for interpretation.

>

> " When you find something this good you should do it, " DeBauche said.

>

> Barry lin, PhD, of Beaumont Hospital in Royal Oak, Mich.,

> agreed that this type of screening wouldn't necessarily need a clinical

> cardiologist since a nurse or other trained staff could administer the ECG.

>

> " It's a very simple test, " he said.

>

> The biggest costs involve setting up the infrastructure, Zipes added.

>

> " We're talking about the lives of youngsters, " he said. " If that were your

> son or daughter, you would want it done. "

>

>

[Guest guest]

I thought mitral valve prolapse was a common condition, that doesn't

disqualify an individual from sports.

Giovanni Ciriani - West Hartford, CT - USA

On Sun, Jan 10, 2010 at 11:37 AM, Ralph Giarnella <ragiarn@...> wrote:

>

>

> I found this alos very interesting

> Ralph Giarnella MD

> Southington Ct USA

>

> ECG Cost-Effective for Screening Student Athletes

> By Crystal Phend, Senior Staff Writer, MedPage Today

> Published: November 16, 2009

> Reviewed by Dori F. Zaleznik, MD; Associate Clinical Professor of Medicine,

> Harvard Medical School, Boston and

> Dorothy Caputo, MA, RN, BC-ADM, CDE, Nurse Planner

>

> Action Points

>

> * Note that the American Heart Association and American College of

> Cardiology guidelines suggest ECG as optional for preparticipation screening

> of student athletes.

>

> * Note that this study was published as an abstract and presented at a

> conference. These data and conclusions should be considered preliminary

> until published in a peer-reviewed journal.

>

> ORLANDO -- Cost issues should no longer keep electrocardiograms out of most

> schools' efforts to screen student athletes for potentially fatal heart

> problems, researchers said here.

>

> Recent declines in the price of ECG machines mean that students can be

> screened for a cost of less than $3 each after an initial investment of

> under $500 per school, according to a study led by DeBauche, MD, of

> Cypress Cardiology in Cypress, Texas.

>

> Addition of 12-lead ECG to screening would cost just $300 per year of life

> saved, DeBauche's group reported at the American Heart Association meeting.

>

> This price was so far below the typical cost-effectiveness threshold of

> $50,000 per life-year that there should no longer be any question about

> adopting ECG in screening, DeBauche said.

>

> His group set up a program to add a one-time ECG for every student

> participating in competitive sports in their suburban Houston school

> district.

>

> Although high school football is enormously popular in Texas where games

> can draw tens of thousands of spectators, like most other states, Texas

> requires only a perfunctory physical exam and completion of a questionnaire

> on possible symptoms and family cardiac history for participation.

>

> ECG is universally acknowledged as more likely to identify serious cardiac

> problems, and it has been adopted as an international standard for screening

> in much of the world.

>

> One prior study from a region in Italy, which pioneered nationwide

> screening of athletes with ECG in the late 1990s, revealed a 90% drop in

> sudden cardiac events after the screening program began. (See National

> Screening Slows Sudden Cardiac Deaths Among Athletes)

>

> But ECG has not been advocated in national guidelines for the U.S. in large

> part because of the cost, Zipes, MD, of Indiana University and a

> past president of the American College of Cardiology, noted.

>

> " The U.S. is behind the times when it comes to screening athletes, " he

> said, calling current efforts in much of the country woefully inadequate.

>

> Scattered U.S. programs have adopted ECG following the Italian model.

> " Everybody agrees, yes, it should be done, but it's optional because we

> don't think we can afford, on a national level, a mandated program, "

> DeBauche said.

>

> At current reimbursement levels, sending all student athletes to the

> hospital or a physician's office for an ECG at about $100 each would cost

> over an estimated $1 billion, DeBauche said.

>

> The program his group designed, though, would cost under $2 million to

> screen all 200,000 U.S. athletes in the ninth grade, which is an optimal age

> to catch problems -- before high school sports but after onset of puberty,

> he said.

>

> The program included providing laptop-based ECG machines for each of 10

> high schools in the school district.

>

> Athletic trainers and other school employees were trained to apply the ECG

> leads according to a diagram, take the ECG with the push of a button, and

> forward the HIPAA compliant electronic file to DeBauche's team for

> interpretation.

>

> Of the 2,057 freshmen screened, 9% (186 students) had an abnormal ECG

> result and were advised to set up a consultation, get a screening

> echocardiogram for diagnosis, or both.

>

> Only 0.6% had a serious enough abnormality to eliminate them from

> participation in competitive sports.

>

> Among the 173 who accepted further examination for their abnormal findings,

> the diagnoses included:

>

> * Eight cases of Wolff-Parkinson-White syndrome

> * 23 cases of left ventricular hypertrophy

> * Three cases of moderate severity mitral valve regurgitation

> * Six cases of right ventricular pulmonary hypertension

> * One case of cardiomyopathy

> * 17 cases of mitral valve prolapse.

>

> One student was found to have noncompaction cardiomyopathy, a clearly

> life-threatening condition that subsequently led to implantation of a

> defibrillator and waitlisting for a heart transplant.

>

> A second case of aortic coartication and the right ventricular

> abnormalities " certainly had major clinical significance, " the researchers

> said.

>

> An echocardiogram to follow-up on abnormal cases could be carried out by

> commercial screening firms specializing in large numbers of relatively easy

> studies and reimbursed by all major insurers, DeBauche said.

>

> The ECG itself would cost only $0.50 per ECG for electrodes and about $2.00

> for interpretation.

>

> " When you find something this good you should do it, " DeBauche said.

>

> Barry lin, PhD, of Beaumont Hospital in Royal Oak, Mich.,

> agreed that this type of screening wouldn't necessarily need a clinical

> cardiologist since a nurse or other trained staff could administer the ECG.

>

> " It's a very simple test, " he said.

>

> The biggest costs involve setting up the infrastructure, Zipes added.

>

> " We're talking about the lives of youngsters, " he said. " If that were your

> son or daughter, you would want it done. "

>

>

[Guest guest]

Yeah. It's fascinating that our ATHLETES at the college level are suffering from

these problems. Imagine if you took a cross section of the rest of them?

Either they're not making young people as well as they used to - or this is

competely out of control in that age group?? (If we screened people in their

40's, would we come up with this many problems in athletic people??) Were people

always this liable to have such heart conditions, particularly prime time

athletes - all along? Is it that we're merely catching things people played

entire pro careers with, without incident?

What I wonder though is if this screening will eventually lead to lawsuits of

" discrimination " for someone not getting their chance or scholarship - based

only on this testing.

Sometimes what institutions believe will save them money costs them more in the

long run?

The Phantom

aka Schaefer, CMT/RMT, competing powerlifter

Denver, Colorado, USA

=================================

Re: ECG Cost-Effective for Screening Student Athletes

I found this alos very interesting

Ralph Giarnella MD

Southington Ct USA

ECG Cost-Effective for Screening Student Athletes

By Crystal Phend, Senior Staff Writer, MedPage Today

Published: November 16, 2009

Reviewed by Dori F. Zaleznik, MD; Associate Clinical Professor of Medicine,

Harvard Medical School, Boston and

Dorothy Caputo, MA, RN, BC-ADM, CDE, Nurse Planner

Action Points

* Note that the American Heart Association and American College of Cardiology

guidelines suggest ECG as optional for preparticipation screening of student

athletes.

* Note that this study was published as an abstract and presented at a

conference. These data and conclusions should be considered preliminary until

published in a peer-reviewed journal.

ORLANDO -- Cost issues should no longer keep electrocardiograms out of most

schools' efforts to screen student athletes for potentially fatal heart

problems, researchers said here.

Recent declines in the price of ECG machines mean that students can be screened

for a cost of less than $3 each after an initial investment of under $500 per

school, according to a study led by DeBauche, MD, of Cypress Cardiology

in Cypress, Texas.

Addition of 12-lead ECG to screening would cost just $300 per year of life

saved, DeBauche's group reported at the American Heart Association meeting.

This price was so far below the typical cost-effectiveness threshold of $50,000

per life-year that there should no longer be any question about adopting ECG in

screening, DeBauche said.

His group set up a program to add a one-time ECG for every student participating

in competitive sports in their suburban Houston school district.

Although high school football is enormously popular in Texas where games can

draw tens of thousands of spectators, like most other states, Texas requires

only a perfunctory physical exam and completion of a questionnaire on possible

symptoms and family cardiac history for participation.

ECG is universally acknowledged as more likely to identify serious cardiac

problems, and it has been adopted as an international standard for screening in

much of the world.

One prior study from a region in Italy, which pioneered nationwide screening of

athletes with ECG in the late 1990s, revealed a 90% drop in sudden cardiac

events after the screening program began. (See National Screening Slows Sudden

Cardiac Deaths Among Athletes)

But ECG has not been advocated in national guidelines for the U.S. in large part

because of the cost, Zipes, MD, of Indiana University and a past

president of the American College of Cardiology, noted.

" The U.S. is behind the times when it comes to screening athletes, " he said,

calling current efforts in much of the country woefully inadequate.

Scattered U.S. programs have adopted ECG following the Italian model. " Everybody

agrees, yes, it should be done, but it's optional because we don't think we can

afford, on a national level, a mandated program, " DeBauche said.

At current reimbursement levels, sending all student athletes to the hospital or

a physician's office for an ECG at about $100 each would cost over an estimated

$1 billion, DeBauche said.

The program his group designed, though, would cost under $2 million to screen

all 200,000 U.S. athletes in the ninth grade, which is an optimal age to catch

problems -- before high school sports but after onset of puberty, he said.

The program included providing laptop-based ECG machines for each of 10 high

schools in the school district.

Athletic trainers and other school employees were trained to apply the ECG leads

according to a diagram, take the ECG with the push of a button, and forward the

HIPAA compliant electronic file to DeBauche's team for interpretation.

Of the 2,057 freshmen screened, 9% (186 students) had an abnormal ECG result and

were advised to set up a consultation, get a screening echocardiogram for

diagnosis, or both.

Only 0.6% had a serious enough abnormality to eliminate them from participation

in competitive sports.

Among the 173 who accepted further examination for their abnormal findings, the

diagnoses included:

* Eight cases of Wolff-Parkinson-White syndrome

* 23 cases of left ventricular hypertrophy

* Three cases of moderate severity mitral valve regurgitation

* Six cases of right ventricular pulmonary hypertension

* One case of cardiomyopathy

* 17 cases of mitral valve prolapse.

One student was found to have noncompaction cardiomyopathy, a clearly

life-threatening condition that subsequently led to implantation of a

defibrillator and waitlisting for a heart transplant.

A second case of aortic coartication and the right ventricular abnormalities

" certainly had major clinical significance, " the researchers said.

An echocardiogram to follow-up on abnormal cases could be carried out by

commercial screening firms specializing in large numbers of relatively easy

studies and reimbursed by all major insurers, DeBauche said.

The ECG itself would cost only $0.50 per ECG for electrodes and about $2.00 for

interpretation.

" When you find something this good you should do it, " DeBauche said.

Barry lin, PhD, of Beaumont Hospital in Royal Oak, Mich., agreed

that this type of screening wouldn't necessarily need a clinical cardiologist

since a nurse or other trained staff could administer the ECG.

" It's a very simple test, " he said.

The biggest costs involve setting up the infrastructure, Zipes added.

" We're talking about the lives of youngsters, " he said. " If that were your son

or daughter, you would want it done. "

[Guest guest]

Yeah. It's fascinating that our ATHLETES at the college level are suffering from

these problems. Imagine if you took a cross section of the rest of them?

Either they're not making young people as well as they used to - or this is

competely out of control in that age group?? (If we screened people in their

40's, would we come up with this many problems in athletic people??) Were people

always this liable to have such heart conditions, particularly prime time

athletes - all along? Is it that we're merely catching things people played

entire pro careers with, without incident?

What I wonder though is if this screening will eventually lead to lawsuits of

" discrimination " for someone not getting their chance or scholarship - based

only on this testing.

Sometimes what institutions believe will save them money costs them more in the

long run?

The Phantom

aka Schaefer, CMT/RMT, competing powerlifter

Denver, Colorado, USA

=================================

Re: ECG Cost-Effective for Screening Student Athletes

I found this alos very interesting

Ralph Giarnella MD

Southington Ct USA

ECG Cost-Effective for Screening Student Athletes

By Crystal Phend, Senior Staff Writer, MedPage Today

Published: November 16, 2009

Reviewed by Dori F. Zaleznik, MD; Associate Clinical Professor of Medicine,

Harvard Medical School, Boston and

Dorothy Caputo, MA, RN, BC-ADM, CDE, Nurse Planner

Action Points

* Note that the American Heart Association and American College of Cardiology

guidelines suggest ECG as optional for preparticipation screening of student

athletes.

* Note that this study was published as an abstract and presented at a

conference. These data and conclusions should be considered preliminary until

published in a peer-reviewed journal.

ORLANDO -- Cost issues should no longer keep electrocardiograms out of most

schools' efforts to screen student athletes for potentially fatal heart

problems, researchers said here.

Recent declines in the price of ECG machines mean that students can be screened

for a cost of less than $3 each after an initial investment of under $500 per

school, according to a study led by DeBauche, MD, of Cypress Cardiology

in Cypress, Texas.

Addition of 12-lead ECG to screening would cost just $300 per year of life

saved, DeBauche's group reported at the American Heart Association meeting.

This price was so far below the typical cost-effectiveness threshold of $50,000

per life-year that there should no longer be any question about adopting ECG in

screening, DeBauche said.

His group set up a program to add a one-time ECG for every student participating

in competitive sports in their suburban Houston school district.

Although high school football is enormously popular in Texas where games can

draw tens of thousands of spectators, like most other states, Texas requires

only a perfunctory physical exam and completion of a questionnaire on possible

symptoms and family cardiac history for participation.

ECG is universally acknowledged as more likely to identify serious cardiac

problems, and it has been adopted as an international standard for screening in

much of the world.

One prior study from a region in Italy, which pioneered nationwide screening of

athletes with ECG in the late 1990s, revealed a 90% drop in sudden cardiac

events after the screening program began. (See National Screening Slows Sudden

Cardiac Deaths Among Athletes)

But ECG has not been advocated in national guidelines for the U.S. in large part

because of the cost, Zipes, MD, of Indiana University and a past

president of the American College of Cardiology, noted.

" The U.S. is behind the times when it comes to screening athletes, " he said,

calling current efforts in much of the country woefully inadequate.

Scattered U.S. programs have adopted ECG following the Italian model. " Everybody

agrees, yes, it should be done, but it's optional because we don't think we can

afford, on a national level, a mandated program, " DeBauche said.

At current reimbursement levels, sending all student athletes to the hospital or

a physician's office for an ECG at about $100 each would cost over an estimated

$1 billion, DeBauche said.

The program his group designed, though, would cost under $2 million to screen

all 200,000 U.S. athletes in the ninth grade, which is an optimal age to catch

problems -- before high school sports but after onset of puberty, he said.

The program included providing laptop-based ECG machines for each of 10 high

schools in the school district.

Athletic trainers and other school employees were trained to apply the ECG leads

according to a diagram, take the ECG with the push of a button, and forward the

HIPAA compliant electronic file to DeBauche's team for interpretation.

Of the 2,057 freshmen screened, 9% (186 students) had an abnormal ECG result and

were advised to set up a consultation, get a screening echocardiogram for

diagnosis, or both.

Only 0.6% had a serious enough abnormality to eliminate them from participation

in competitive sports.

Among the 173 who accepted further examination for their abnormal findings, the

diagnoses included:

* Eight cases of Wolff-Parkinson-White syndrome

* 23 cases of left ventricular hypertrophy

* Three cases of moderate severity mitral valve regurgitation

* Six cases of right ventricular pulmonary hypertension

* One case of cardiomyopathy

* 17 cases of mitral valve prolapse.

One student was found to have noncompaction cardiomyopathy, a clearly

life-threatening condition that subsequently led to implantation of a

defibrillator and waitlisting for a heart transplant.

A second case of aortic coartication and the right ventricular abnormalities

" certainly had major clinical significance, " the researchers said.

An echocardiogram to follow-up on abnormal cases could be carried out by

commercial screening firms specializing in large numbers of relatively easy

studies and reimbursed by all major insurers, DeBauche said.

The ECG itself would cost only $0.50 per ECG for electrodes and about $2.00 for

interpretation.

" When you find something this good you should do it, " DeBauche said.

Barry lin, PhD, of Beaumont Hospital in Royal Oak, Mich., agreed

that this type of screening wouldn't necessarily need a clinical cardiologist

since a nurse or other trained staff could administer the ECG.

" It's a very simple test, " he said.

The biggest costs involve setting up the infrastructure, Zipes added.

" We're talking about the lives of youngsters, " he said. " If that were your son

or daughter, you would want it done. "

[Guest guest]

I don't believe the authors indicated that Mitral Valve Prolapse was an

indication for disqulification. However Mitral Valve Prolapse is not totally

benign. Some individuals may develop episodes of supraventricular tachycardia

which can be very troublesome and they need to use beta blockers to prevent the

episodes.

Ralph Giarnella MD

Southington Ct USA

________________________________

From: Giovanni Ciriani <Giovanni.Ciriani@...>

Supertraining

Sent: Sun, January 10, 2010 3:30:34 PM

Subject: Re: ECG Cost-Effective for Screening Student Athletes

I thought mitral valve prolapse was a common condition, that doesn't

disqualify an individual from sports.

Giovanni Ciriani - West Hartford, CT - USA

On Sun, Jan 10, 2010 at 11:37 AM, Ralph Giarnella <ragiarn (DOT) com> wrote:

>

>

> I found this alos very interesting

> Ralph Giarnella MD

> Southington Ct USA

>

> ECG Cost-Effective for Screening Student Athletes

> By Crystal Phend, Senior Staff Writer, MedPage Today

> Published: November 16, 2009

> Reviewed by Dori F. Zaleznik, MD; Associate Clinical Professor of Medicine,

> Harvard Medical School, Boston and

> Dorothy Caputo, MA, RN, BC-ADM, CDE, Nurse Planner

>

> Action Points

>

> * Note that the American Heart Association and American College of

> Cardiology guidelines suggest ECG as optional for preparticipation screening

> of student athletes.

>

> * Note that this study was published as an abstract and presented at a

> conference. These data and conclusions should be considered preliminary

> until published in a peer-reviewed journal.

>

> ORLANDO -- Cost issues should no longer keep electrocardiograms out of most

> schools' efforts to screen student athletes for potentially fatal heart

> problems, researchers said here.

>

> Recent declines in the price of ECG machines mean that students can be

> screened for a cost of less than $3 each after an initial investment of

> under $500 per school, according to a study led by DeBauche, MD, of

> Cypress Cardiology in Cypress, Texas.

>

> Addition of 12-lead ECG to screening would cost just $300 per year of life

> saved, DeBauche's group reported at the American Heart Association meeting.

>

> This price was so far below the typical cost-effectiveness threshold of

> $50,000 per life-year that there should no longer be any question about

> adopting ECG in screening, DeBauche said.

>

> His group set up a program to add a one-time ECG for every student

> participating in competitive sports in their suburban Houston school

> district.

>

> Although high school football is enormously popular in Texas where games

> can draw tens of thousands of spectators, like most other states, Texas

> requires only a perfunctory physical exam and completion of a questionnaire

> on possible symptoms and family cardiac history for participation.

>

> ECG is universally acknowledged as more likely to identify serious cardiac

> problems, and it has been adopted as an international standard for screening

> in much of the world.

>

> One prior study from a region in Italy, which pioneered nationwide

> screening of athletes with ECG in the late 1990s, revealed a 90% drop in

> sudden cardiac events after the screening program began. (See National

> Screening Slows Sudden Cardiac Deaths Among Athletes)

>

> But ECG has not been advocated in national guidelines for the U.S. in large

> part because of the cost, Zipes, MD, of Indiana University and a

> past president of the American College of Cardiology, noted.

>

> " The U.S. is behind the times when it comes to screening athletes, " he

> said, calling current efforts in much of the country woefully inadequate.

>

> Scattered U.S. programs have adopted ECG following the Italian model.

> " Everybody agrees, yes, it should be done, but it's optional because we

> don't think we can afford, on a national level, a mandated program, "

> DeBauche said.

>

> At current reimbursement levels, sending all student athletes to the

> hospital or a physician's office for an ECG at about $100 each would cost

> over an estimated $1 billion, DeBauche said.

>

> The program his group designed, though, would cost under $2 million to

> screen all 200,000 U.S. athletes in the ninth grade, which is an optimal age

> to catch problems -- before high school sports but after onset of puberty,

> he said.

>

> The program included providing laptop-based ECG machines for each of 10

> high schools in the school district.

>

> Athletic trainers and other school employees were trained to apply the ECG

> leads according to a diagram, take the ECG with the push of a button, and

> forward the HIPAA compliant electronic file to DeBauche's team for

> interpretation.

>

> Of the 2,057 freshmen screened, 9% (186 students) had an abnormal ECG

> result and were advised to set up a consultation, get a screening

> echocardiogram for diagnosis, or both.

>

> Only 0.6% had a serious enough abnormality to eliminate them from

> participation in competitive sports.

>

> Among the 173 who accepted further examination for their abnormal findings,

> the diagnoses included:

>

> * Eight cases of Wolff-Parkinson- White syndrome

> * 23 cases of left ventricular hypertrophy

> * Three cases of moderate severity mitral valve regurgitation

> * Six cases of right ventricular pulmonary hypertension

> * One case of cardiomyopathy

> * 17 cases of mitral valve prolapse.

>

> One student was found to have noncompaction cardiomyopathy, a clearly

> life-threatening condition that subsequently led to implantation of a

> defibrillator and waitlisting for a heart transplant.

>

> A second case of aortic coartication and the right ventricular

> abnormalities " certainly had major clinical significance, " the researchers

> said.

>

> An echocardiogram to follow-up on abnormal cases could be carried out by

> commercial screening firms specializing in large numbers of relatively easy

> studies and reimbursed by all major insurers, DeBauche said.

>

> The ECG itself would cost only $0.50 per ECG for electrodes and about $2.00

> for interpretation.

>

> " When you find something this good you should do it, " DeBauche said.

>

> Barry lin, PhD, of Beaumont Hospital in Royal Oak, Mich.,

> agreed that this type of screening wouldn't necessarily need a clinical

> cardiologist since a nurse or other trained staff could administer the ECG.

>

> " It's a very simple test, " he said.

>

> The biggest costs involve setting up the infrastructure, Zipes added.

>

> " We're talking about the lives of youngsters, " he said. " If that were your

> son or daughter, you would want it done. "

>

>

[Guest guest]

Young people have been dying from sudden cardiac death for a long time. It is

not common and generally does not make the local news or the local newspaper for

that matter.

I know of several athletes in our community who have died of sudden cardiac

death. Two particular cases come to mind.

The first is a young athlete (19) who died while playing a basketball pick up

game. It occurred in the mid- 70s. I was serving as assistant at the time and

had fill out a report for the State medical examiner. This never made the local

TV news or newspaper.

A second case was a basketball player at a local college. This case did make

the news. He had been seen by our hospital's cardiologist because of some

abnormality- I do not have the specifics. The cardiologist made a diagnosis

which disqualified the athlete for playing because of a high risk of sudden

death.

He went to England to play and was cleared there. He subsequently filed a

lawsuit against the hospital cardiologist. The lawsuit was dropped when he died

while playing basketball in England. It made the local news and If I am not

mistaken the national news.

Another case involved a basketball player at a Nationally ranked basketball

program. I believe it was in the 80s. He had had an episode of cardiac

arrythmia and was advised to not play. He played any way and died during a

basketball game. I believe the college was in California and if I am not

mistaken the program was Mt. St. which at the time was in the top 10. That

definitely made the national news.

Some day a parent is going to sue a school district for not screening properly.

Sudden cardiac death is not a frequent occurrence. However when it does occur

it is a tragedy made worse if it could have been prevent with proper screening.

I am posting another article that will shed more light on this subject.

Ralph Giarnella MD

Southington Ct USA

________________________________

From: " deadliftdiva@... " <deadliftdiva@...>

Supertraining

Sent: Sun, January 10, 2010 8:12:34 PM

Subject: Re: ECG Cost-Effective for Screening Student Athletes

Yeah. It's fascinating that our ATHLETES at the college level are suffering from

these problems. Imagine if you took a cross section of the rest of them?

Either they're not making young people as well as they used to - or this is

competely out of control in that age group?? (If we screened people in their

40's, would we come up with this many problems in athletic people??) Were people

always this liable to have such heart conditions, particularly prime time

athletes - all along? Is it that we're merely catching things people played

entire pro careers with, without incident?

What I wonder though is if this screening will eventually lead to lawsuits of

" discrimination " for someone not getting their chance or scholarship - based

only on this testing.

Sometimes what institutions believe will save them money costs them more in the

long run?

The Phantom

aka Schaefer, CMT/RMT, competing powerlifter

Denver, Colorado, USA

============ ========= ========= ===

Re: ECG Cost-Effective for Screening Student Athletes

I found this alos very interesting

Ralph Giarnella MD

Southington Ct USA

ECG Cost-Effective for Screening Student Athletes

By Crystal Phend, Senior Staff Writer, MedPage Today

Published: November 16, 2009

Reviewed by Dori F. Zaleznik, MD; Associate Clinical Professor of Medicine,

Harvard Medical School, Boston and

Dorothy Caputo, MA, RN, BC-ADM, CDE, Nurse Planner

Action Points

* Note that the American Heart Association and American College of Cardiology

guidelines suggest ECG as optional for preparticipation screening of student

athletes.

* Note that this study was published as an abstract and presented at a

conference. These data and conclusions should be considered preliminary until

published in a peer-reviewed journal.

ORLANDO -- Cost issues should no longer keep electrocardiograms out of most

schools' efforts to screen student athletes for potentially fatal heart

problems, researchers said here.

Recent declines in the price of ECG machines mean that students can be screened

for a cost of less than $3 each after an initial investment of under $500 per

school, according to a study led by DeBauche, MD, of Cypress Cardiology

in Cypress, Texas.

Addition of 12-lead ECG to screening would cost just $300 per year of life

saved, DeBauche's group reported at the American Heart Association meeting.

This price was so far below the typical cost-effectiveness threshold of $50,000

per life-year that there should no longer be any question about adopting ECG in

screening, DeBauche said.

His group set up a program to add a one-time ECG for every student participating

in competitive sports in their suburban Houston school district.

Although high school football is enormously popular in Texas where games can

draw tens of thousands of spectators, like most other states, Texas requires

only a perfunctory physical exam and completion of a questionnaire on possible

symptoms and family cardiac history for participation.

ECG is universally acknowledged as more likely to identify serious cardiac

problems, and it has been adopted as an international standard for screening in

much of the world.

One prior study from a region in Italy, which pioneered nationwide screening of

athletes with ECG in the late 1990s, revealed a 90% drop in sudden cardiac

events after the screening program began. (See National Screening Slows Sudden

Cardiac Deaths Among Athletes)

But ECG has not been advocated in national guidelines for the U.S. in large part

because of the cost, Zipes, MD, of Indiana University and a past

president of the American College of Cardiology, noted.

" The U.S. is behind the times when it comes to screening athletes, " he said,

calling current efforts in much of the country woefully inadequate.

Scattered U.S. programs have adopted ECG following the Italian model. " Everybody

agrees, yes, it should be done, but it's optional because we don't think we can

afford, on a national level, a mandated program, " DeBauche said.

At current reimbursement levels, sending all student athletes to the hospital or

a physician's office for an ECG at about $100 each would cost over an estimated

$1 billion, DeBauche said.

The program his group designed, though, would cost under $2 million to screen

all 200,000 U.S. athletes in the ninth grade, which is an optimal age to catch

problems -- before high school sports but after onset of puberty, he said.

The program included providing laptop-based ECG machines for each of 10 high

schools in the school district.

Athletic trainers and other school employees were trained to apply the ECG leads

according to a diagram, take the ECG with the push of a button, and forward the

HIPAA compliant electronic file to DeBauche's team for interpretation.

Of the 2,057 freshmen screened, 9% (186 students) had an abnormal ECG result and

were advised to set up a consultation, get a screening echocardiogram for

diagnosis, or both.

Only 0.6% had a serious enough abnormality to eliminate them from participation

in competitive sports.

Among the 173 who accepted further examination for their abnormal findings, the

diagnoses included:

* Eight cases of Wolff-Parkinson- White syndrome

* 23 cases of left ventricular hypertrophy

* Three cases of moderate severity mitral valve regurgitation

* Six cases of right ventricular pulmonary hypertension

* One case of cardiomyopathy

* 17 cases of mitral valve prolapse.

One student was found to have noncompaction cardiomyopathy, a clearly

life-threatening condition that subsequently led to implantation of a

defibrillator and waitlisting for a heart transplant.

A second case of aortic coartication and the right ventricular abnormalities

" certainly had major clinical significance, " the researchers said.

An echocardiogram to follow-up on abnormal cases could be carried out by

commercial screening firms specializing in large numbers of relatively easy

studies and reimbursed by all major insurers, DeBauche said.

The ECG itself would cost only $0.50 per ECG for electrodes and about $2.00 for

interpretation.

" When you find something this good you should do it, " DeBauche said.

Barry lin, PhD, of Beaumont Hospital in Royal Oak, Mich., agreed

that this type of screening wouldn't necessarily need a clinical cardiologist

since a nurse or other trained staff could administer the ECG.

" It's a very simple test, " he said.

The biggest costs involve setting up the infrastructure, Zipes added.

" We're talking about the lives of youngsters, " he said. " If that were your son

or daughter, you would want it done. "

[Guest guest]

Relevant excerpts to the recent post:

Should Electrocardiograms Be Used as Part of a Preparticipation Physical

Examination to Decrease the Risk of Sudden Cardiac Death?

Riewald, PhD, CSCS, NSCA-CPT

Riewald, PhD, CSCS

Strength and Conditioning Journal:

December 2009 - Volume 31 - Issue 6 - pp 95-96

Every year, we hear at least one story of a young athlete who died on the

athletic field, the product of some previously undiagnosed cardiac condition.

The results are tragic, and we are often left asking why this happened and if

there was any way these all could have been prevented. When asked this question,

many people immediately think of the preparticipation physical examination

(PPE), which is required by many sports organizations, and look to see if a test

could be performed to screen athletes and identify risks before they step on the

field of play. The PPE, which typically requires an athlete to undergo a

physical examination as well as complete a medical history questionnaire, is

used to identify potential injuries or illnesses that may preclude an athlete

from participating safely in the athletic program. Yet unless an athlete has a

family history to suggest there may be a risk of cardiovascular disease, most

cardiac conditions will fly under the radar with a " standard " PPE.

Recently, more and more individuals and organizations have been advocating the

use of electrocardiograms (ECGs or EKGs), or even more expensive

echocardiograms, as part of the preparticipation screening. Electrocardiograms

provide information specific to the working of the heart-information that can

help increase the chances of detecting a cardiac condition. On paper, inclusion

of an ECG makes perfect sense, but keep in mind there are trade-offs that must

be taken into account when deciding to include an ECG as part of the PPE.

Recently, in Medicine and Science in Sports and Exercise, Lawless and Best (1)

put together a summary of the research related to the effectiveness and success

of using ECGs to identify cardiac risk factors in young athletes.

In reviewing the available literature, the authors highlight a number of

important results that should be taken into consideration when weighing the pros

and cons of including such a test in a PPE. Some of the points made from the

research include

* Some of the most comprehensive work with ECGs has been done in Italy, where

comprehensive screening has reduced the incidence of sudden cardiac death by 89%

over a 26-year period.

* Electrocardiograms can accurately diagnose between 75 and 95% of the athletes

with hypertrophic cardiac myopathy, a condition characterized by a thickening of

the heart's walls and one that has received a lot of press due to several recent

athlete deaths.

* The inclusion of an ECG can increase the overall sensitivity of a PPE (the

proportion of athletes with a heart condition who are correctly identified by

the test) considerably over the " standard " PPE-from 2.5 to 6% to as much as 51

to 95%-depending on the type of underlying condition and the population being

evaluated.

* Yet at the same time, false positives can be as high as 40%, meaning athletes

who do not truly have a heart condition could be excluded from participation

based on a false finding, and

* Even when athletes demonstrate a normal or only mildly abnormal ECG, there is

still as much as a 4 to 5% chance, there is an undetected underlying heart

condition (so, the test still will not identify everyone with a heart

condition).

* Most of the available data have been collected from a homogeneous pool of

subjects, predominantly adult Caucasians. There is reason to believe that ECGs

in athletic African Americans may differ from these data, and drawing

conclusions from the available data may lead to improper diagnoses in this group

of athletes. Additionally, adults can show markedly different ECGs compared to

youth and adolescents. Many of the " recognizable features " that suggest an

underlying heart condition, in fact, may not present themselves until adulthood.

* The heart responds and adapts to exercise, and it is not uncommon to see

" changes " in the ECGs of well-trained athletes. Are these " abnormalities " a

reflection of a heart condition or do they reflect a normal adaptation to

exercise? Also, data indicate that the " normal " changes may be more pronounced

in some sports compared with others, making interpretation increasingly

difficult.

* There presently is no " gold standard " for evaluating ECGs, and it is not

uncommon for health care professionals in the United States to analyze the same

ECG and come away with different conclusions about the health of the athlete.

* There is also the cost associated with conducting ECGs and any subsequent more

discriminating tests that will need to be conducted to verify the results of a

positive ECG.

This is a lot to consider when making a decision about whether to include an ECG

as part of a PPE. On the one hand, you may feel that athlete's health should

trump all other decisions. But if you are requiring a test to be a part of a

PPE, you would also like that test to have 100% accuracy in diagnosing

underlying heart conditions. Taking these factors into account, the American

Heart Association has recommended that ECGs need not be a mandatory part of a

PPE screening for athletes. They cite the costs associated with testing a large

number of athletes, the number of false positives (as well as the costs

associated with further evaluating false positives), the lack of randomized

controlled studies to demonstrate the superiority of the ECG over a traditional

PPE, the lack of normative data in youth and certain demographics, and the

variability inherent to ECG interpretation as the primary factors motivating

their recommendation.

=====================

Carruthers

Wakefield, UK

>

> I found this alos very interesting

> Ralph Giarnella MD

> Southington Ct USA

>

> ECG Cost-Effective for Screening Student Athletes

> By Crystal Phend, Senior Staff Writer, MedPage Today

> Published: November 16, 2009

> Reviewed by Dori F. Zaleznik, MD; Associate Clinical Professor of Medicine,

Harvard Medical School, Boston and

> Dorothy Caputo, MA, RN, BC-ADM, CDE, Nurse Planner

>

> Action Points

>

> * Note that the American Heart Association and American College of

Cardiology guidelines suggest ECG as optional for preparticipation screening of

student athletes.

>

>

> * Note that this study was published as an abstract and presented at a

conference. These data and conclusions should be considered preliminary until

published in a peer-reviewed journal.

>

> ORLANDO -- Cost issues should no longer keep electrocardiograms out of most

schools' efforts to screen student athletes for potentially fatal heart

problems, researchers said here.

>

> Recent declines in the price of ECG machines mean that students can be

screened for a cost of less than $3 each after an initial investment of under

$500 per school, according to a study led by DeBauche, MD, of Cypress

Cardiology in Cypress, Texas.

>

> Addition of 12-lead ECG to screening would cost just $300 per year of life

saved, DeBauche's group reported at the American Heart Association meeting.

>

> This price was so far below the typical cost-effectiveness threshold of

$50,000 per life-year that there should no longer be any question about adopting

ECG in screening, DeBauche said.

>

> His group set up a program to add a one-time ECG for every student

participating in competitive sports in their suburban Houston school district.

>

> Although high school football is enormously popular in Texas where games can

draw tens of thousands of spectators, like most other states, Texas requires

only a perfunctory physical exam and completion of a questionnaire on possible

symptoms and family cardiac history for participation.

>

> ECG is universally acknowledged as more likely to identify serious cardiac

problems, and it has been adopted as an international standard for screening in

much of the world.

>

> One prior study from a region in Italy, which pioneered nationwide screening

of athletes with ECG in the late 1990s, revealed a 90% drop in sudden cardiac

events after the screening program began. (See National Screening Slows Sudden

Cardiac Deaths Among Athletes)

>

> But ECG has not been advocated in national guidelines for the U.S. in large

part because of the cost, Zipes, MD, of Indiana University and a past

president of the American College of Cardiology, noted.

>

> " The U.S. is behind the times when it comes to screening athletes, " he said,

calling current efforts in much of the country woefully inadequate.

>

> Scattered U.S. programs have adopted ECG following the Italian model.

" Everybody agrees, yes, it should be done, but it's optional because we don't

think we can afford, on a national level, a mandated program, " DeBauche said.

>

> At current reimbursement levels, sending all student athletes to the hospital

or a physician's office for an ECG at about $100 each would cost over an

estimated $1 billion, DeBauche said.

>

> The program his group designed, though, would cost under $2 million to screen

all 200,000 U.S. athletes in the ninth grade, which is an optimal age to catch

problems -- before high school sports but after onset of puberty, he said.

>

> The program included providing laptop-based ECG machines for each of 10 high

schools in the school district.

>

> Athletic trainers and other school employees were trained to apply the ECG

leads according to a diagram, take the ECG with the push of a button, and

forward the HIPAA compliant electronic file to DeBauche's team for

interpretation.

>

> Of the 2,057 freshmen screened, 9% (186 students) had an abnormal ECG result

and were advised to set up a consultation, get a screening echocardiogram for

diagnosis, or both.

>

> Only 0.6% had a serious enough abnormality to eliminate them from

participation in competitive sports.

>

> Among the 173 who accepted further examination for their abnormal findings,

the diagnoses included:

>

> * Eight cases of Wolff-Parkinson-White syndrome

> * 23 cases of left ventricular hypertrophy

> * Three cases of moderate severity mitral valve regurgitation

> * Six cases of right ventricular pulmonary hypertension

> * One case of cardiomyopathy

> * 17 cases of mitral valve prolapse.

>

> One student was found to have noncompaction cardiomyopathy, a clearly

life-threatening condition that subsequently led to implantation of a

defibrillator and waitlisting for a heart transplant.

>

> A second case of aortic coartication and the right ventricular abnormalities

" certainly had major clinical significance, " the researchers said.

>

> An echocardiogram to follow-up on abnormal cases could be carried out by

commercial screening firms specializing in large numbers of relatively easy

studies and reimbursed by all major insurers, DeBauche said.

>

> The ECG itself would cost only $0.50 per ECG for electrodes and about $2.00

for interpretation.

>

> " When you find something this good you should do it, " DeBauche said.

>

> Barry lin, PhD, of Beaumont Hospital in Royal Oak, Mich., agreed

that this type of screening wouldn't necessarily need a clinical cardiologist

since a nurse or other trained staff could administer the ECG.

>

> " It's a very simple test, " he said.

>

> The biggest costs involve setting up the infrastructure, Zipes added.

>

> " We're talking about the lives of youngsters, " he said. " If that were your son

or daughter, you would want it done. "

>

>

>

[Guest guest]

in the article below " The heart responds and adapts to exercise, and it is

not uncommon to see " changes " in the ECGs of well-trained athletes. " made

me wonder if the heart tests should exclude athletes or have us the trainer

identify better training patterns to allow adaption to the sport? What do

others think?

As an example I know that my asthma (very mild) improves dramatically with

improved conditioning, I just can't go at it with out well planned

progression.

Regards

Nick Tatalias

Johannesburg

South Africa

2010/1/14 carruthersjam <Carruthersjam@...>

>

>

>

> Relevant excerpts to the recent post:

>

> Should Electrocardiograms Be Used as Part of a Preparticipation Physical

> Examination to Decrease the Risk of Sudden Cardiac Death?

> Riewald, PhD, CSCS, NSCA-CPT

>

> Riewald, PhD, CSCS

>

> Strength and Conditioning Journal:

> December 2009 - Volume 31 - Issue 6 - pp 95-96

>

> Every year, we hear at least one story of a young athlete who died on the

> athletic field, the product of some previously undiagnosed cardiac

> condition. The results are tragic, and we are often left asking why this

> happened and if there was any way these all could have been prevented. When

> asked this question, many people immediately think of the preparticipation

> physical examination (PPE), which is required by many sports organizations,

> and look to see if a test could be performed to screen athletes and identify

> risks before they step on the field of play. The PPE, which typically

> requires an athlete to undergo a physical examination as well as complete a

> medical history questionnaire, is used to identify potential injuries or

> illnesses that may preclude an athlete from participating safely in the

> athletic program. Yet unless an athlete has a family history to suggest

> there may be a risk of cardiovascular disease, most cardiac conditions will

> fly under the radar with a " standard " PPE.

> Recently, more and more individuals and organizations have been advocating

> the use of electrocardiograms (ECGs or EKGs), or even more expensive

> echocardiograms, as part of the preparticipation screening.

> Electrocardiograms provide information specific to the working of the

> heart-information that can help increase the chances of detecting a cardiac

> condition. On paper, inclusion of an ECG makes perfect sense, but keep in

> mind there are trade-offs that must be taken into account when deciding to

> include an ECG as part of the PPE. Recently, in Medicine and Science in

> Sports and Exercise, Lawless and Best (1) put together a summary of the

> research related to the effectiveness and success of using ECGs to identify

> cardiac risk factors in young athletes.

>

> In reviewing the available literature, the authors highlight a number of

> important results that should be taken into consideration when weighing the

> pros and cons of including such a test in a PPE. Some of the points made

> from the research include

> * Some of the most comprehensive work with ECGs has been done in Italy,

> where comprehensive screening has reduced the incidence of sudden cardiac

> death by 89% over a 26-year period.

> * Electrocardiograms can accurately diagnose between 75 and 95% of the

> athletes with hypertrophic cardiac myopathy, a condition characterized by a

> thickening of the heart's walls and one that has received a lot of press due

> to several recent athlete deaths.

> * The inclusion of an ECG can increase the overall sensitivity of a PPE

> (the proportion of athletes with a heart condition who are correctly

> identified by the test) considerably over the " standard " PPE-from 2.5 to 6%

> to as much as 51 to 95%-depending on the type of underlying condition and

> the population being evaluated.

> * Yet at the same time, false positives can be as high as 40%, meaning

> athletes who do not truly have a heart condition could be excluded from

> participation based on a false finding, and

> * Even when athletes demonstrate a normal or only mildly abnormal ECG,

> there is still as much as a 4 to 5% chance, there is an undetected

> underlying heart condition (so, the test still will not identify everyone

> with a heart condition).

> * Most of the available data have been collected from a homogeneous pool of

> subjects, predominantly adult Caucasians. There is reason to believe that

> ECGs in athletic African Americans may differ from these data, and drawing

> conclusions from the available data may lead to improper diagnoses in this

> group of athletes. Additionally, adults can show markedly different ECGs

> compared to youth and adolescents. Many of the " recognizable features " that

> suggest an underlying heart condition, in fact, may not present themselves

> until adulthood.

> * The heart responds and adapts to exercise, and it is not uncommon to see

> " changes " in the ECGs of well-trained athletes. Are these " abnormalities " a

> reflection of a heart condition or do they reflect a normal adaptation to

> exercise? Also, data indicate that the " normal " changes may be more

> pronounced in some sports compared with others, making interpretation

> increasingly difficult.

> * There presently is no " gold standard " for evaluating ECGs, and it is not

> uncommon for health care professionals in the United States to analyze the

> same ECG and come away with different conclusions about the health of the

> athlete.

> * There is also the cost associated with conducting ECGs and any subsequent

> more discriminating tests that will need to be conducted to verify the

> results of a positive ECG.

>

> This is a lot to consider when making a decision about whether to include

> an ECG as part of a PPE. On the one hand, you may feel that athlete's health

> should trump all other decisions. But if you are requiring a test to be a

> part of a PPE, you would also like that test to have 100% accuracy in

> diagnosing underlying heart conditions. Taking these factors into account,

> the American Heart Association has recommended that ECGs need not be a

> mandatory part of a PPE screening for athletes. They cite the costs

> associated with testing a large number of athletes, the number of false

> positives (as well as the costs associated with further evaluating false

> positives), the lack of randomized controlled studies to demonstrate the

> superiority of the ECG over a traditional PPE, the lack of normative data in

> youth and certain demographics, and the variability inherent to ECG

> interpretation as the primary factors motivating their recommendation.

>

> =====================

> Carruthers

> Wakefield, UK

>

>

>

> >

> > I found this alos very interesting

> > Ralph Giarnella MD

> > Southington Ct USA

> >

> > ECG Cost-Effective for Screening Student Athletes

> > By Crystal Phend, Senior Staff Writer, MedPage Today

> > Published: November 16, 2009

> > Reviewed by Dori F. Zaleznik, MD; Associate Clinical Professor of

> Medicine, Harvard Medical School, Boston and

> > Dorothy Caputo, MA, RN, BC-ADM, CDE, Nurse Planner

> >

> > Action Points

> >

> > * Note that the American Heart Association and American College of

> Cardiology guidelines suggest ECG as optional for preparticipation screening

> of student athletes.

> >

> >

> > * Note that this study was published as an abstract and presented at a

> conference. These data and conclusions should be considered preliminary

> until published in a peer-reviewed journal.

> >

> > ORLANDO -- Cost issues should no longer keep electrocardiograms out of

> most schools' efforts to screen student athletes for potentially fatal heart

> problems, researchers said here.

> >

> > Recent declines in the price of ECG machines mean that students can be

> screened for a cost of less than $3 each after an initial investment of

> under $500 per school, according to a study led by DeBauche, MD, of

> Cypress Cardiology in Cypress, Texas.

> >

> > Addition of 12-lead ECG to screening would cost just $300 per year of

> life saved, DeBauche's group reported at the American Heart Association

> meeting.

> >

> > This price was so far below the typical cost-effectiveness threshold of

> $50,000 per life-year that there should no longer be any question about

> adopting ECG in screening, DeBauche said.

> >

> > His group set up a program to add a one-time ECG for every student

> participating in competitive sports in their suburban Houston school

> district.

> >

> > Although high school football is enormously popular in Texas where games

> can draw tens of thousands of spectators, like most other states, Texas

> requires only a perfunctory physical exam and completion of a questionnaire

> on possible symptoms and family cardiac history for participation.

> >

> > ECG is universally acknowledged as more likely to identify serious

> cardiac problems, and it has been adopted as an international standard for

> screening in much of the world.

> >

> > One prior study from a region in Italy, which pioneered nationwide

> screening of athletes with ECG in the late 1990s, revealed a 90% drop in

> sudden cardiac events after the screening program began. (See National

> Screening Slows Sudden Cardiac Deaths Among Athletes)

> >

> > But ECG has not been advocated in national guidelines for the U.S. in

> large part because of the cost, Zipes, MD, of Indiana University and

> a past president of the American College of Cardiology, noted.

> >

> > " The U.S. is behind the times when it comes to screening athletes, " he

> said, calling current efforts in much of the country woefully inadequate.

> >

> > Scattered U.S. programs have adopted ECG following the Italian model.

> " Everybody agrees, yes, it should be done, but it's optional because we

> don't think we can afford, on a national level, a mandated program, "

> DeBauche said.

> >

> > At current reimbursement levels, sending all student athletes to the

> hospital or a physician's office for an ECG at about $100 each would cost

> over an estimated $1 billion, DeBauche said.

> >

> > The program his group designed, though, would cost under $2 million to

> screen all 200,000 U.S. athletes in the ninth grade, which is an optimal age

> to catch problems -- before high school sports but after onset of puberty,

> he said.

> >

> > The program included providing laptop-based ECG machines for each of 10

> high schools in the school district.

> >

> > Athletic trainers and other school employees were trained to apply the

> ECG leads according to a diagram, take the ECG with the push of a button,

> and forward the HIPAA compliant electronic file to DeBauche's team for

> interpretation.

> >

> > Of the 2,057 freshmen screened, 9% (186 students) had an abnormal ECG

> result and were advised to set up a consultation, get a screening

> echocardiogram for diagnosis, or both.

> >

> > Only 0.6% had a serious enough abnormality to eliminate them from

> participation in competitive sports.

> >

> > Among the 173 who accepted further examination for their abnormal

> findings, the diagnoses included:

> >

> > * Eight cases of Wolff-Parkinson-White syndrome

> > * 23 cases of left ventricular hypertrophy

> > * Three cases of moderate severity mitral valve regurgitation

> > * Six cases of right ventricular pulmonary hypertension

> > * One case of cardiomyopathy

> > * 17 cases of mitral valve prolapse.

> >

> > One student was found to have noncompaction cardiomyopathy, a clearly

> life-threatening condition that subsequently led to implantation of a

> defibrillator and waitlisting for a heart transplant.

> >

> > A second case of aortic coartication and the right ventricular

> abnormalities " certainly had major clinical significance, " the researchers

> said.

> >

> > An echocardiogram to follow-up on abnormal cases could be carried out by

> commercial screening firms specializing in large numbers of relatively easy

> studies and reimbursed by all major insurers, DeBauche said.

> >

> > The ECG itself would cost only $0.50 per ECG for electrodes and about

> $2.00 for interpretation.

> >

> > " When you find something this good you should do it, " DeBauche said.

> >

> > Barry lin, PhD, of Beaumont Hospital in Royal Oak, Mich.,

> agreed that this type of screening wouldn't necessarily need a clinical

> cardiologist since a nurse or other trained staff could administer the ECG.

> >

> > " It's a very simple test, " he said.

> >

> > The biggest costs involve setting up the infrastructure, Zipes added.

> >

> > " We're talking about the lives of youngsters, " he said. " If that were

> your son or daughter, you would want it done. "

> >

> >

> >

[Guest guest]

in the article below " The heart responds and adapts to exercise, and it is

not uncommon to see " changes " in the ECGs of well-trained athletes. " made

me wonder if the heart tests should exclude athletes or have us the trainer

identify better training patterns to allow adaption to the sport? What do

others think?

As an example I know that my asthma (very mild) improves dramatically with

improved conditioning, I just can't go at it with out well planned

progression.

Regards

Nick Tatalias

Johannesburg

South Africa

2010/1/14 carruthersjam <Carruthersjam@...>

>

>

>

> Relevant excerpts to the recent post:

>

> Should Electrocardiograms Be Used as Part of a Preparticipation Physical

> Examination to Decrease the Risk of Sudden Cardiac Death?

> Riewald, PhD, CSCS, NSCA-CPT

>

> Riewald, PhD, CSCS

>

> Strength and Conditioning Journal:

> December 2009 - Volume 31 - Issue 6 - pp 95-96

>

> Every year, we hear at least one story of a young athlete who died on the

> athletic field, the product of some previously undiagnosed cardiac

> condition. The results are tragic, and we are often left asking why this

> happened and if there was any way these all could have been prevented. When

> asked this question, many people immediately think of the preparticipation

> physical examination (PPE), which is required by many sports organizations,

> and look to see if a test could be performed to screen athletes and identify

> risks before they step on the field of play. The PPE, which typically

> requires an athlete to undergo a physical examination as well as complete a

> medical history questionnaire, is used to identify potential injuries or

> illnesses that may preclude an athlete from participating safely in the

> athletic program. Yet unless an athlete has a family history to suggest

> there may be a risk of cardiovascular disease, most cardiac conditions will

> fly under the radar with a " standard " PPE.

> Recently, more and more individuals and organizations have been advocating

> the use of electrocardiograms (ECGs or EKGs), or even more expensive

> echocardiograms, as part of the preparticipation screening.

> Electrocardiograms provide information specific to the working of the

> heart-information that can help increase the chances of detecting a cardiac

> condition. On paper, inclusion of an ECG makes perfect sense, but keep in

> mind there are trade-offs that must be taken into account when deciding to

> include an ECG as part of the PPE. Recently, in Medicine and Science in

> Sports and Exercise, Lawless and Best (1) put together a summary of the

> research related to the effectiveness and success of using ECGs to identify

> cardiac risk factors in young athletes.

>

> In reviewing the available literature, the authors highlight a number of

> important results that should be taken into consideration when weighing the

> pros and cons of including such a test in a PPE. Some of the points made

> from the research include

> * Some of the most comprehensive work with ECGs has been done in Italy,

> where comprehensive screening has reduced the incidence of sudden cardiac

> death by 89% over a 26-year period.

> * Electrocardiograms can accurately diagnose between 75 and 95% of the

> athletes with hypertrophic cardiac myopathy, a condition characterized by a

> thickening of the heart's walls and one that has received a lot of press due

> to several recent athlete deaths.

> * The inclusion of an ECG can increase the overall sensitivity of a PPE

> (the proportion of athletes with a heart condition who are correctly

> identified by the test) considerably over the " standard " PPE-from 2.5 to 6%

> to as much as 51 to 95%-depending on the type of underlying condition and

> the population being evaluated.

> * Yet at the same time, false positives can be as high as 40%, meaning

> athletes who do not truly have a heart condition could be excluded from

> participation based on a false finding, and

> * Even when athletes demonstrate a normal or only mildly abnormal ECG,

> there is still as much as a 4 to 5% chance, there is an undetected

> underlying heart condition (so, the test still will not identify everyone

> with a heart condition).

> * Most of the available data have been collected from a homogeneous pool of

> subjects, predominantly adult Caucasians. There is reason to believe that

> ECGs in athletic African Americans may differ from these data, and drawing

> conclusions from the available data may lead to improper diagnoses in this

> group of athletes. Additionally, adults can show markedly different ECGs

> compared to youth and adolescents. Many of the " recognizable features " that

> suggest an underlying heart condition, in fact, may not present themselves

> until adulthood.

> * The heart responds and adapts to exercise, and it is not uncommon to see

> " changes " in the ECGs of well-trained athletes. Are these " abnormalities " a

> reflection of a heart condition or do they reflect a normal adaptation to

> exercise? Also, data indicate that the " normal " changes may be more

> pronounced in some sports compared with others, making interpretation

> increasingly difficult.

> * There presently is no " gold standard " for evaluating ECGs, and it is not

> uncommon for health care professionals in the United States to analyze the

> same ECG and come away with different conclusions about the health of the

> athlete.

> * There is also the cost associated with conducting ECGs and any subsequent

> more discriminating tests that will need to be conducted to verify the

> results of a positive ECG.

>

> This is a lot to consider when making a decision about whether to include

> an ECG as part of a PPE. On the one hand, you may feel that athlete's health

> should trump all other decisions. But if you are requiring a test to be a

> part of a PPE, you would also like that test to have 100% accuracy in

> diagnosing underlying heart conditions. Taking these factors into account,

> the American Heart Association has recommended that ECGs need not be a

> mandatory part of a PPE screening for athletes. They cite the costs

> associated with testing a large number of athletes, the number of false

> positives (as well as the costs associated with further evaluating false

> positives), the lack of randomized controlled studies to demonstrate the

> superiority of the ECG over a traditional PPE, the lack of normative data in

> youth and certain demographics, and the variability inherent to ECG

> interpretation as the primary factors motivating their recommendation.

>

> =====================

> Carruthers

> Wakefield, UK

>

>

>

> >

> > I found this alos very interesting

> > Ralph Giarnella MD

> > Southington Ct USA

> >

> > ECG Cost-Effective for Screening Student Athletes

> > By Crystal Phend, Senior Staff Writer, MedPage Today

> > Published: November 16, 2009

> > Reviewed by Dori F. Zaleznik, MD; Associate Clinical Professor of

> Medicine, Harvard Medical School, Boston and

> > Dorothy Caputo, MA, RN, BC-ADM, CDE, Nurse Planner

> >

> > Action Points

> >

> > * Note that the American Heart Association and American College of

> Cardiology guidelines suggest ECG as optional for preparticipation screening

> of student athletes.

> >

> >

> > * Note that this study was published as an abstract and presented at a

> conference. These data and conclusions should be considered preliminary

> until published in a peer-reviewed journal.

> >

> > ORLANDO -- Cost issues should no longer keep electrocardiograms out of

> most schools' efforts to screen student athletes for potentially fatal heart

> problems, researchers said here.

> >

> > Recent declines in the price of ECG machines mean that students can be

> screened for a cost of less than $3 each after an initial investment of

> under $500 per school, according to a study led by DeBauche, MD, of

> Cypress Cardiology in Cypress, Texas.

> >

> > Addition of 12-lead ECG to screening would cost just $300 per year of

> life saved, DeBauche's group reported at the American Heart Association

> meeting.

> >

> > This price was so far below the typical cost-effectiveness threshold of

> $50,000 per life-year that there should no longer be any question about

> adopting ECG in screening, DeBauche said.

> >

> > His group set up a program to add a one-time ECG for every student

> participating in competitive sports in their suburban Houston school

> district.

> >

> > Although high school football is enormously popular in Texas where games

> can draw tens of thousands of spectators, like most other states, Texas

> requires only a perfunctory physical exam and completion of a questionnaire

> on possible symptoms and family cardiac history for participation.

> >

> > ECG is universally acknowledged as more likely to identify serious

> cardiac problems, and it has been adopted as an international standard for

> screening in much of the world.

> >

> > One prior study from a region in Italy, which pioneered nationwide

> screening of athletes with ECG in the late 1990s, revealed a 90% drop in

> sudden cardiac events after the screening program began. (See National

> Screening Slows Sudden Cardiac Deaths Among Athletes)

> >

> > But ECG has not been advocated in national guidelines for the U.S. in

> large part because of the cost, Zipes, MD, of Indiana University and

> a past president of the American College of Cardiology, noted.

> >

> > " The U.S. is behind the times when it comes to screening athletes, " he

> said, calling current efforts in much of the country woefully inadequate.

> >

> > Scattered U.S. programs have adopted ECG following the Italian model.

> " Everybody agrees, yes, it should be done, but it's optional because we

> don't think we can afford, on a national level, a mandated program, "

> DeBauche said.

> >

> > At current reimbursement levels, sending all student athletes to the

> hospital or a physician's office for an ECG at about $100 each would cost

> over an estimated $1 billion, DeBauche said.

> >

> > The program his group designed, though, would cost under $2 million to

> screen all 200,000 U.S. athletes in the ninth grade, which is an optimal age

> to catch problems -- before high school sports but after onset of puberty,

> he said.

> >

> > The program included providing laptop-based ECG machines for each of 10

> high schools in the school district.

> >

> > Athletic trainers and other school employees were trained to apply the

> ECG leads according to a diagram, take the ECG with the push of a button,

> and forward the HIPAA compliant electronic file to DeBauche's team for

> interpretation.

> >

> > Of the 2,057 freshmen screened, 9% (186 students) had an abnormal ECG

> result and were advised to set up a consultation, get a screening

> echocardiogram for diagnosis, or both.

> >

> > Only 0.6% had a serious enough abnormality to eliminate them from

> participation in competitive sports.

> >

> > Among the 173 who accepted further examination for their abnormal

> findings, the diagnoses included:

> >

> > * Eight cases of Wolff-Parkinson-White syndrome

> > * 23 cases of left ventricular hypertrophy

> > * Three cases of moderate severity mitral valve regurgitation

> > * Six cases of right ventricular pulmonary hypertension

> > * One case of cardiomyopathy

> > * 17 cases of mitral valve prolapse.

> >

> > One student was found to have noncompaction cardiomyopathy, a clearly

> life-threatening condition that subsequently led to implantation of a

> defibrillator and waitlisting for a heart transplant.

> >

> > A second case of aortic coartication and the right ventricular

> abnormalities " certainly had major clinical significance, " the researchers

> said.

> >

> > An echocardiogram to follow-up on abnormal cases could be carried out by

> commercial screening firms specializing in large numbers of relatively easy

> studies and reimbursed by all major insurers, DeBauche said.

> >

> > The ECG itself would cost only $0.50 per ECG for electrodes and about

> $2.00 for interpretation.

> >

> > " When you find something this good you should do it, " DeBauche said.

> >

> > Barry lin, PhD, of Beaumont Hospital in Royal Oak, Mich.,

> agreed that this type of screening wouldn't necessarily need a clinical

> cardiologist since a nurse or other trained staff could administer the ECG.

> >

> > " It's a very simple test, " he said.

> >

> > The biggest costs involve setting up the infrastructure, Zipes added.

> >

> > " We're talking about the lives of youngsters, " he said. " If that were

> your son or daughter, you would want it done. "

> >

> >

> >

[Guest guest]

While training does change the ekg somewhat there is a definite difference

between hypertrophic cardiomyopathy (patholigic enlargement of the heart) and

athletic enalarged heart. A simple ECG would not necessarily differentiate

however another test (echocardiogram) would.

Screening tests are never 100%. They are meant to point out potential problems

which need further investigation. It is important that they are inexpensive and

easy to perform on large number of people. It is also important that there are

minimal false negatives. There will be more false positives but that is why

positives will need closer evaluation.

It seems strange that Italy has been able to do this screening for the past 20

years and perhaps save many lives and yet we seem to find it burdensome.

Unfortunately it might take the death of a student and subsequent multimillion

dollar lawsuit against a school district to make it feasible.

Italy was pro-active we seem to be reactive. Wait until a crisis to change the

way we do things.

Ralph Giarnella MD

Southington Ct USA

________________________________

From: Nick Tatalias <nick.tatalias@...>

Supertraining

Sent: Fri, January 15, 2010 1:57:16 AM

Subject: Re: Re: ECG Cost-Effective for Screening Student

Athletes

in the article below " The heart responds and adapts to exercise, and it is

not uncommon to see " changes " in the ECGs of well-trained athletes. " made

me wonder if the heart tests should exclude athletes or have us the trainer

identify better training patterns to allow adaption to the sport? What do

others think?

As an example I know that my asthma (very mild) improves dramatically with

improved conditioning, I just can't go at it with out well planned

progression.

Regards

Nick Tatalias

Johannesburg

South Africa

2010/1/14 carruthersjam <Carruthersjam@ aol.com>

>

>

>

> Relevant excerpts to the recent post:

>

> Should Electrocardiograms Be Used as Part of a Preparticipation Physical

> Examination to Decrease the Risk of Sudden Cardiac Death?

> Riewald, PhD, CSCS, NSCA-CPT

>

> Riewald, PhD, CSCS

>

> Strength and Conditioning Journal:

> December 2009 - Volume 31 - Issue 6 - pp 95-96

>

> Every year, we hear at least one story of a young athlete who died on the

> athletic field, the product of some previously undiagnosed cardiac

> condition. The results are tragic, and we are often left asking why this

> happened and if there was any way these all could have been prevented. When

> asked this question, many people immediately think of the preparticipation

> physical examination (PPE), which is required by many sports organizations,

> and look to see if a test could be performed to screen athletes and identify

> risks before they step on the field of play. The PPE, which typically

> requires an athlete to undergo a physical examination as well as complete a

> medical history questionnaire, is used to identify potential injuries or

> illnesses that may preclude an athlete from participating safely in the

> athletic program. Yet unless an athlete has a family history to suggest

> there may be a risk of cardiovascular disease, most cardiac conditions will

> fly under the radar with a " standard " PPE.

> Recently, more and more individuals and organizations have been advocating

> the use of electrocardiograms (ECGs or EKGs), or even more expensive

> echocardiograms, as part of the preparticipation screening.

> Electrocardiograms provide information specific to the working of the

> heart-information that can help increase the chances of detecting a cardiac

> condition. On paper, inclusion of an ECG makes perfect sense, but keep in

> mind there are trade-offs that must be taken into account when deciding to

> include an ECG as part of the PPE. Recently, in Medicine and Science in

> Sports and Exercise, Lawless and Best (1) put together a summary of the

> research related to the effectiveness and success of using ECGs to identify

> cardiac risk factors in young athletes.

>

> In reviewing the available literature, the authors highlight a number of

> important results that should be taken into consideration when weighing the

> pros and cons of including such a test in a PPE. Some of the points made

> from the research include

> * Some of the most comprehensive work with ECGs has been done in Italy,

> where comprehensive screening has reduced the incidence of sudden cardiac

> death by 89% over a 26-year period..

> * Electrocardiograms can accurately diagnose between 75 and 95% of the

> athletes with hypertrophic cardiac myopathy, a condition characterized by a

> thickening of the heart's walls and one that has received a lot of press due

> to several recent athlete deaths.

> * The inclusion of an ECG can increase the overall sensitivity of a PPE

> (the proportion of athletes with a heart condition who are correctly

> identified by the test) considerably over the " standard " PPE-from 2.5 to 6%

> to as much as 51 to 95%-depending on the type of underlying condition and

> the population being evaluated.

> * Yet at the same time, false positives can be as high as 40%, meaning

> athletes who do not truly have a heart condition could be excluded from

> participation based on a false finding, and

> * Even when athletes demonstrate a normal or only mildly abnormal ECG,

> there is still as much as a 4 to 5% chance, there is an undetected

> underlying heart condition (so, the test still will not identify everyone

> with a heart condition).

> * Most of the available data have been collected from a homogeneous pool of

> subjects, predominantly adult Caucasians. There is reason to believe that

> ECGs in athletic African Americans may differ from these data, and drawing

> conclusions from the available data may lead to improper diagnoses in this

> group of athletes. Additionally, adults can show markedly different ECGs

> compared to youth and adolescents. Many of the " recognizable features " that

> suggest an underlying heart condition, in fact, may not present themselves

> until adulthood.

> * The heart responds and adapts to exercise, and it is not uncommon to see

> " changes " in the ECGs of well-trained athletes. Are these " abnormalities " a

> reflection of a heart condition or do they reflect a normal adaptation to

> exercise? Also, data indicate that the " normal " changes may be more

> pronounced in some sports compared with others, making interpretation

> increasingly difficult.

> * There presently is no " gold standard " for evaluating ECGs, and it is not

> uncommon for health care professionals in the United States to analyze the

> same ECG and come away with different conclusions about the health of the

> athlete.

> * There is also the cost associated with conducting ECGs and any subsequent

> more discriminating tests that will need to be conducted to verify the

> results of a positive ECG.

>

> This is a lot to consider when making a decision about whether to include

> an ECG as part of a PPE. On the one hand, you may feel that athlete's health

> should trump all other decisions. But if you are requiring a test to be a

> part of a PPE, you would also like that test to have 100% accuracy in

> diagnosing underlying heart conditions. Taking these factors into account,

> the American Heart Association has recommended that ECGs need not be a

> mandatory part of a PPE screening for athletes. They cite the costs

> associated with testing a large number of athletes, the number of false

> positives (as well as the costs associated with further evaluating false

> positives), the lack of randomized controlled studies to demonstrate the

> superiority of the ECG over a traditional PPE, the lack of normative data in

> youth and certain demographics, and the variability inherent to ECG

> interpretation as the primary factors motivating their recommendation.

>

> ============ =========

> Carruthers

> Wakefield, UK

>

>

>

> >

> > I found this alos very interesting

> > Ralph Giarnella MD

> > Southington Ct USA

> >

> > ECG Cost-Effective for Screening Student Athletes

> > By Crystal Phend, Senior Staff Writer, MedPage Today

> > Published: November 16, 2009

> > Reviewed by Dori F. Zaleznik, MD; Associate Clinical Professor of

> Medicine, Harvard Medical School, Boston and

> > Dorothy Caputo, MA, RN, BC-ADM, CDE, Nurse Planner

> >

> > Action Points

> >

> > * Note that the American Heart Association and American College of

> Cardiology guidelines suggest ECG as optional for preparticipation screening

> of student athletes.

> >

> >

> > * Note that this study was published as an abstract and presented at a

> conference. These data and conclusions should be considered preliminary

> until published in a peer-reviewed journal.

> >

> > ORLANDO -- Cost issues should no longer keep electrocardiograms out of

> most schools' efforts to screen student athletes for potentially fatal heart

> problems, researchers said here.

> >

> > Recent declines in the price of ECG machines mean that students can be

> screened for a cost of less than $3 each after an initial investment of

> under $500 per school, according to a study led by DeBauche, MD, of

> Cypress Cardiology in Cypress, Texas.

> >

> > Addition of 12-lead ECG to screening would cost just $300 per year of

> life saved, DeBauche's group reported at the American Heart Association

> meeting.

> >

> > This price was so far below the typical cost-effectiveness threshold of

> $50,000 per life-year that there should no longer be any question about

> adopting ECG in screening, DeBauche said.

> >

> > His group set up a program to add a one-time ECG for every student

> participating in competitive sports in their suburban Houston school

> district.

> >

> > Although high school football is enormously popular in Texas where games

> can draw tens of thousands of spectators, like most other states, Texas

> requires only a perfunctory physical exam and completion of a questionnaire

> on possible symptoms and family cardiac history for participation.

> >

> > ECG is universally acknowledged as more likely to identify serious

> cardiac problems, and it has been adopted as an international standard for

> screening in much of the world.

> >

> > One prior study from a region in Italy, which pioneered nationwide

> screening of athletes with ECG in the late 1990s, revealed a 90% drop in

> sudden cardiac events after the screening program began. (See National

> Screening Slows Sudden Cardiac Deaths Among Athletes)

> >

> > But ECG has not been advocated in national guidelines for the U.S. in

> large part because of the cost, Zipes, MD, of Indiana University and

> a past president of the American College of Cardiology, noted.

> >

> > " The U.S. is behind the times when it comes to screening athletes, " he

> said, calling current efforts in much of the country woefully inadequate.

> >

> > Scattered U.S. programs have adopted ECG following the Italian model.

> " Everybody agrees, yes, it should be done, but it's optional because we

> don't think we can afford, on a national level, a mandated program, "

> DeBauche said.

> >

> > At current reimbursement levels, sending all student athletes to the

> hospital or a physician's office for an ECG at about $100 each would cost

> over an estimated $1 billion, DeBauche said.

> >

> > The program his group designed, though, would cost under $2 million to

> screen all 200,000 U.S. athletes in the ninth grade, which is an optimal age

> to catch problems -- before high school sports but after onset of puberty,

> he said.

> >

> > The program included providing laptop-based ECG machines for each of 10

> high schools in the school district.

> >

> > Athletic trainers and other school employees were trained to apply the

> ECG leads according to a diagram, take the ECG with the push of a button,

> and forward the HIPAA compliant electronic file to DeBauche's team for

> interpretation.

> >

> > Of the 2,057 freshmen screened, 9% (186 students) had an abnormal ECG

> result and were advised to set up a consultation, get a screening

> echocardiogram for diagnosis, or both.

> >

> > Only 0.6% had a serious enough abnormality to eliminate them from

> participation in competitive sports.

> >

> > Among the 173 who accepted further examination for their abnormal

> findings, the diagnoses included:

> >

> > * Eight cases of Wolff-Parkinson- White syndrome

> > * 23 cases of left ventricular hypertrophy

> > * Three cases of moderate severity mitral valve regurgitation

> > * Six cases of right ventricular pulmonary hypertension

> > * One case of cardiomyopathy

> > * 17 cases of mitral valve prolapse.

> >

> > One student was found to have noncompaction cardiomyopathy, a clearly

> life-threatening condition that subsequently led to implantation of a

> defibrillator and waitlisting for a heart transplant.

> >

> > A second case of aortic coartication and the right ventricular

> abnormalities " certainly had major clinical significance, " the researchers

> said.

> >

> > An echocardiogram to follow-up on abnormal cases could be carried out by

> commercial screening firms specializing in large numbers of relatively easy

> studies and reimbursed by all major insurers, DeBauche said.

> >

> > The ECG itself would cost only $0.50 per ECG for electrodes and about

> $2.00 for interpretation.

> >

> > " When you find something this good you should do it, " DeBauche said.

> >

> > Barry lin, PhD, of Beaumont Hospital in Royal Oak, Mich.,

> agreed that this type of screening wouldn't necessarily need a clinical

> cardiologist since a nurse or other trained staff could administer the ECG.

> >

> > " It's a very simple test, " he said.

> >

> > The biggest costs involve setting up the infrastructure, Zipes added.

> >

> > " We're talking about the lives of youngsters, " he said. " If that were

> your son or daughter, you would want it done. "

> >

> >

> >

[Guest guest]

While training does change the ekg somewhat there is a definite difference

between hypertrophic cardiomyopathy (patholigic enlargement of the heart) and

athletic enalarged heart. A simple ECG would not necessarily differentiate

however another test (echocardiogram) would.

Screening tests are never 100%. They are meant to point out potential problems

which need further investigation. It is important that they are inexpensive and

easy to perform on large number of people. It is also important that there are

minimal false negatives. There will be more false positives but that is why

positives will need closer evaluation.

It seems strange that Italy has been able to do this screening for the past 20

years and perhaps save many lives and yet we seem to find it burdensome.

Unfortunately it might take the death of a student and subsequent multimillion

dollar lawsuit against a school district to make it feasible.

Italy was pro-active we seem to be reactive. Wait until a crisis to change the

way we do things.

Ralph Giarnella MD

Southington Ct USA

________________________________

From: Nick Tatalias <nick.tatalias@...>

Supertraining

Sent: Fri, January 15, 2010 1:57:16 AM

Subject: Re: Re: ECG Cost-Effective for Screening Student

Athletes

in the article below " The heart responds and adapts to exercise, and it is

not uncommon to see " changes " in the ECGs of well-trained athletes. " made

me wonder if the heart tests should exclude athletes or have us the trainer

identify better training patterns to allow adaption to the sport? What do

others think?

As an example I know that my asthma (very mild) improves dramatically with

improved conditioning, I just can't go at it with out well planned

progression.

Regards

Nick Tatalias

Johannesburg

South Africa

2010/1/14 carruthersjam <Carruthersjam@ aol.com>

>

>

>

> Relevant excerpts to the recent post:

>

> Should Electrocardiograms Be Used as Part of a Preparticipation Physical

> Examination to Decrease the Risk of Sudden Cardiac Death?

> Riewald, PhD, CSCS, NSCA-CPT

>

> Riewald, PhD, CSCS

>

> Strength and Conditioning Journal:

> December 2009 - Volume 31 - Issue 6 - pp 95-96

>

> Every year, we hear at least one story of a young athlete who died on the

> athletic field, the product of some previously undiagnosed cardiac

> condition. The results are tragic, and we are often left asking why this

> happened and if there was any way these all could have been prevented. When

> asked this question, many people immediately think of the preparticipation

> physical examination (PPE), which is required by many sports organizations,

> and look to see if a test could be performed to screen athletes and identify

> risks before they step on the field of play. The PPE, which typically

> requires an athlete to undergo a physical examination as well as complete a

> medical history questionnaire, is used to identify potential injuries or

> illnesses that may preclude an athlete from participating safely in the

> athletic program. Yet unless an athlete has a family history to suggest

> there may be a risk of cardiovascular disease, most cardiac conditions will

> fly under the radar with a " standard " PPE.

> Recently, more and more individuals and organizations have been advocating

> the use of electrocardiograms (ECGs or EKGs), or even more expensive

> echocardiograms, as part of the preparticipation screening.

> Electrocardiograms provide information specific to the working of the

> heart-information that can help increase the chances of detecting a cardiac

> condition. On paper, inclusion of an ECG makes perfect sense, but keep in

> mind there are trade-offs that must be taken into account when deciding to

> include an ECG as part of the PPE. Recently, in Medicine and Science in

> Sports and Exercise, Lawless and Best (1) put together a summary of the

> research related to the effectiveness and success of using ECGs to identify

> cardiac risk factors in young athletes.

>

> In reviewing the available literature, the authors highlight a number of

> important results that should be taken into consideration when weighing the

> pros and cons of including such a test in a PPE. Some of the points made

> from the research include

> * Some of the most comprehensive work with ECGs has been done in Italy,

> where comprehensive screening has reduced the incidence of sudden cardiac

> death by 89% over a 26-year period..

> * Electrocardiograms can accurately diagnose between 75 and 95% of the

> athletes with hypertrophic cardiac myopathy, a condition characterized by a

> thickening of the heart's walls and one that has received a lot of press due

> to several recent athlete deaths.

> * The inclusion of an ECG can increase the overall sensitivity of a PPE

> (the proportion of athletes with a heart condition who are correctly

> identified by the test) considerably over the " standard " PPE-from 2.5 to 6%

> to as much as 51 to 95%-depending on the type of underlying condition and

> the population being evaluated.

> * Yet at the same time, false positives can be as high as 40%, meaning

> athletes who do not truly have a heart condition could be excluded from

> participation based on a false finding, and

> * Even when athletes demonstrate a normal or only mildly abnormal ECG,

> there is still as much as a 4 to 5% chance, there is an undetected

> underlying heart condition (so, the test still will not identify everyone

> with a heart condition).

> * Most of the available data have been collected from a homogeneous pool of

> subjects, predominantly adult Caucasians. There is reason to believe that

> ECGs in athletic African Americans may differ from these data, and drawing

> conclusions from the available data may lead to improper diagnoses in this

> group of athletes. Additionally, adults can show markedly different ECGs

> compared to youth and adolescents. Many of the " recognizable features " that

> suggest an underlying heart condition, in fact, may not present themselves

> until adulthood.

> * The heart responds and adapts to exercise, and it is not uncommon to see

> " changes " in the ECGs of well-trained athletes. Are these " abnormalities " a

> reflection of a heart condition or do they reflect a normal adaptation to

> exercise? Also, data indicate that the " normal " changes may be more

> pronounced in some sports compared with others, making interpretation

> increasingly difficult.

> * There presently is no " gold standard " for evaluating ECGs, and it is not

> uncommon for health care professionals in the United States to analyze the

> same ECG and come away with different conclusions about the health of the

> athlete.

> * There is also the cost associated with conducting ECGs and any subsequent

> more discriminating tests that will need to be conducted to verify the

> results of a positive ECG.

>

> This is a lot to consider when making a decision about whether to include

> an ECG as part of a PPE. On the one hand, you may feel that athlete's health

> should trump all other decisions. But if you are requiring a test to be a

> part of a PPE, you would also like that test to have 100% accuracy in

> diagnosing underlying heart conditions. Taking these factors into account,

> the American Heart Association has recommended that ECGs need not be a

> mandatory part of a PPE screening for athletes. They cite the costs

> associated with testing a large number of athletes, the number of false

> positives (as well as the costs associated with further evaluating false

> positives), the lack of randomized controlled studies to demonstrate the

> superiority of the ECG over a traditional PPE, the lack of normative data in

> youth and certain demographics, and the variability inherent to ECG

> interpretation as the primary factors motivating their recommendation.

>

> ============ =========

> Carruthers

> Wakefield, UK

>

>

>

> >

> > I found this alos very interesting

> > Ralph Giarnella MD

> > Southington Ct USA

> >

> > ECG Cost-Effective for Screening Student Athletes

> > By Crystal Phend, Senior Staff Writer, MedPage Today

> > Published: November 16, 2009

> > Reviewed by Dori F. Zaleznik, MD; Associate Clinical Professor of

> Medicine, Harvard Medical School, Boston and

> > Dorothy Caputo, MA, RN, BC-ADM, CDE, Nurse Planner

> >

> > Action Points

> >

> > * Note that the American Heart Association and American College of

> Cardiology guidelines suggest ECG as optional for preparticipation screening

> of student athletes.

> >

> >

> > * Note that this study was published as an abstract and presented at a

> conference. These data and conclusions should be considered preliminary

> until published in a peer-reviewed journal.

> >

> > ORLANDO -- Cost issues should no longer keep electrocardiograms out of

> most schools' efforts to screen student athletes for potentially fatal heart

> problems, researchers said here.

> >

> > Recent declines in the price of ECG machines mean that students can be

> screened for a cost of less than $3 each after an initial investment of

> under $500 per school, according to a study led by DeBauche, MD, of

> Cypress Cardiology in Cypress, Texas.

> >

> > Addition of 12-lead ECG to screening would cost just $300 per year of

> life saved, DeBauche's group reported at the American Heart Association

> meeting.

> >

> > This price was so far below the typical cost-effectiveness threshold of

> $50,000 per life-year that there should no longer be any question about

> adopting ECG in screening, DeBauche said.

> >

> > His group set up a program to add a one-time ECG for every student

> participating in competitive sports in their suburban Houston school

> district.

> >

> > Although high school football is enormously popular in Texas where games

> can draw tens of thousands of spectators, like most other states, Texas

> requires only a perfunctory physical exam and completion of a questionnaire

> on possible symptoms and family cardiac history for participation.

> >

> > ECG is universally acknowledged as more likely to identify serious

> cardiac problems, and it has been adopted as an international standard for

> screening in much of the world.

> >

> > One prior study from a region in Italy, which pioneered nationwide

> screening of athletes with ECG in the late 1990s, revealed a 90% drop in

> sudden cardiac events after the screening program began. (See National

> Screening Slows Sudden Cardiac Deaths Among Athletes)

> >

> > But ECG has not been advocated in national guidelines for the U.S. in

> large part because of the cost, Zipes, MD, of Indiana University and

> a past president of the American College of Cardiology, noted.

> >

> > " The U.S. is behind the times when it comes to screening athletes, " he

> said, calling current efforts in much of the country woefully inadequate.

> >

> > Scattered U.S. programs have adopted ECG following the Italian model.

> " Everybody agrees, yes, it should be done, but it's optional because we

> don't think we can afford, on a national level, a mandated program, "

> DeBauche said.

> >

> > At current reimbursement levels, sending all student athletes to the

> hospital or a physician's office for an ECG at about $100 each would cost

> over an estimated $1 billion, DeBauche said.

> >

> > The program his group designed, though, would cost under $2 million to

> screen all 200,000 U.S. athletes in the ninth grade, which is an optimal age

> to catch problems -- before high school sports but after onset of puberty,

> he said.

> >

> > The program included providing laptop-based ECG machines for each of 10

> high schools in the school district.

> >

> > Athletic trainers and other school employees were trained to apply the

> ECG leads according to a diagram, take the ECG with the push of a button,

> and forward the HIPAA compliant electronic file to DeBauche's team for

> interpretation.

> >

> > Of the 2,057 freshmen screened, 9% (186 students) had an abnormal ECG

> result and were advised to set up a consultation, get a screening

> echocardiogram for diagnosis, or both.

> >

> > Only 0.6% had a serious enough abnormality to eliminate them from

> participation in competitive sports.

> >

> > Among the 173 who accepted further examination for their abnormal

> findings, the diagnoses included:

> >

> > * Eight cases of Wolff-Parkinson- White syndrome

> > * 23 cases of left ventricular hypertrophy

> > * Three cases of moderate severity mitral valve regurgitation

> > * Six cases of right ventricular pulmonary hypertension

> > * One case of cardiomyopathy

> > * 17 cases of mitral valve prolapse.

> >

> > One student was found to have noncompaction cardiomyopathy, a clearly

> life-threatening condition that subsequently led to implantation of a

> defibrillator and waitlisting for a heart transplant.

> >

> > A second case of aortic coartication and the right ventricular

> abnormalities " certainly had major clinical significance, " the researchers

> said.

> >

> > An echocardiogram to follow-up on abnormal cases could be carried out by

> commercial screening firms specializing in large numbers of relatively easy

> studies and reimbursed by all major insurers, DeBauche said.

> >

> > The ECG itself would cost only $0.50 per ECG for electrodes and about

> $2.00 for interpretation.

> >

> > " When you find something this good you should do it, " DeBauche said.

> >

> > Barry lin, PhD, of Beaumont Hospital in Royal Oak, Mich.,

> agreed that this type of screening wouldn't necessarily need a clinical

> cardiologist since a nurse or other trained staff could administer the ECG.

> >

> > " It's a very simple test, " he said.

> >

> > The biggest costs involve setting up the infrastructure, Zipes added.

> >

> > " We're talking about the lives of youngsters, " he said. " If that were

> your son or daughter, you would want it done. "

> >

> >

> >