Re: ECG Cost-Effective for Screening Student Athletes

[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

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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. "