Study: Screening Program Reduces Sudden Cardiac Deaths

Oct. 3, 2006 — -- Ryan Owens, 16, and a lineman on the Henderson County High School football team in Henderson, Ky., went to football practice last month.

After practice, he collapsed and shortly died. The death came as a shock to the people of Henderson.

Owens died of an unusual heart rhythm, brought on by heat and an undiagnosed heart problem.

He never had any symptoms prior to his collapse.

Deaths like this are a parent's worst nightmare, but unfortunately, his case is not unique.

About 335,000 people a year die of coronary heart disease before being admitted to a hospital or even making it to an emergency room, according to the American Heart Association.

Health officials call this Sudden Cardiac Death or SCD.

Most victims are older, but a few cases involve young athletes, who appear to be in the peak of physical health and have no symptoms of impending doom.

SCD is a phenomenon that is seen worldwide in which a previously healthy person has some form of heart problem that leads to sudden death.

Most of these are related to a class of heart problems known as cardiomyopathies in which the heart muscle is diseased, leading to pump and rhythm problems.

In the United States, there have been numerous high-profile SCD cases involving young athletes:

In 2005, NFL lineman Thomas Herrion died following a preseason game. Herrion collapsed in the locker room and was transported to a hospital in Denver where he was pronounced dead.

In 1993, Reggie Lewis, a Boston Celtics basketball star, died during a pickup basketball game.

Skater Sergei Grinkov collapsed and died on the ice during a practice in 1995.

NBA center Jason Collier died in 2004 of an enlarged heart that his family said he was unaware of. Since Collier's death, the NBA has instituted mandatory cardiac screening for its players.

The National Federation of State High School Associations estimates 10 SCD cases to 25 SCD cases per year in individuals younger than 30 years in the United States.

In 1982, Italy implemented a program to try and reduce SCDs by performing screening on all 12- to 35-year-olds who planned to participate in any strenuous competitive sport.

The program uses family history, personal history, a physical exam and an ECG to determine risk of SCD.

No analysis had ever been performed to see whether the program had actually made a difference, until now.

In the Oct. 4 issue of the Journal of the American Medical Association, scientists from the University of Padua Medical School in Italy looked at the numbers and found some impressive statistics.

During the 24 years that the program has been used, the annual deaths among athletes have decreased by 89 percent.

Nonathlete-related spontaneous cardiac death has remained stable during this same time period.

Initially young athletes were five times more likely to suffer from SCD than nonathletes.

Now they are half as likely, suggesting that the program may benefit all young people.

Experts believe that the United States is close to such screening techniques for athletes.

"Virtually all high schools and universities use guidelines promulgated by the AmericanAcademy of Sports Medicine," said Peter Schulman, a cardiologist and associate professor of medicine at the University of Connecticut School of Medicine.

"They follow most of the guidelines that are used in Italy, except for the ECG."

One of the concerns of adding ECGs is the cost.

In the Italian study, they say that the average cost of an ECG about $40.

Those that have abnormal findings then have to undergo further testing to prove or disprove whether the person really has a problem.

The financial costs quickly add up when compared to the very few deaths the program would prevent in the United States, some experts say.

"There are relatively few sudden deaths in athletes in total," said Douglas Zipes, director emeritus of the division of cardiology and the Krannert Institute of Cardiology at the Indiana School of Medicine. "But when they happen, they are riveting in the public consciousness and are particularly tragic."

There is also concern about young athletes that will not be able to participate because of false findings.

"How many athletes were prevented from competitive athletics by the screening?" Zipes said. "Who didn't need to be excluded and thus had an unnecessary lifestyle change?"

This is a very important consideration in a country faced with an obesity epidemic, and physical activity should be encouraged as much as possible.

This indicates a need for tests that confirm whether the person really has a problem. The Italian data showed that 3,914 people were referred for further studies secondary to suspicious findings.

Of these, 879 were eventually restricted from participation, resulting in the 89 percent reduction in yearly SCDs.

"Even with the standard screening done properly, it's impossible to prevent all sudden deaths on the athletic field," Schulman said.

With these concerns in mind, experts are still supportive of this type of system in the United States.

"We should use this evidence to push such a program in the U.S.," said Alan Kadish, senior associate chief of the cardiology division at Northwestern University.

Christine Lawless is an associate professor of internal medicine at Ohio State University in Columbus, Ohio. She is in the process of studying such a program.

"We offer both ECG and echocardiographic screening to all our athletes as part of a research project whose main objective is to correlate the ECG findings with underlying cardiac structure and with ethnic background of the athlete," Lawless said.

Several other universities and school systems throughout the country are testing similar systems. The success of these programs will be used to determine whether a nationwide program is possible.