Routine Heart Screening for Kids – the Future of Pediatric Heart Care?

Dec. 4, 2009— -- Routine heart screening for adolescents is currently not deemed necessary in the United States, but without it, the congenital heart defect that left a hole in Madelinne d'Aversa's heart would have gone undetected until it created more serious issues, such as heart failure and lung damage.

On a whim, Madelinne's grandmother volunteered her to have her heart checked as part of a local research project known as the Houston Early Age Risk Testing and Screening – HEARTS for short. Madelinne was in sixth grade at the time.

Though she showed no outward signs of a heart condition, the scanning showed a hole in her heart that required surgery.

"It was really emotional at first, because up until now, she had been perfect -- no issues," said Madelinne's mother, Shana Harvey.

"Down the road [this could have caused damage] that was irreversible," she said, adding that they are so grateful doctors were able to catch the problem.

Since her surgery Aug. 3, Madelinne has made a full recovery and now she is back to playing volleyball and dancing at school -- everything's "back to normal," she said.

Led by Dr. John Higgins, a cardiologist at Memorial Hermann Hospital and a professor of cardiology at the University of Texas Medical School at Houston, HEARTS is currently providing heart screening to sixth-graders around Houston and -- contingent on future funding -- hopes eventually to screen all sixth-graders in Texas.

Last spring, HEARTS kicked off its research at Key Middle School in Houston and is continuing now at nearby Fleming Middle School, screening 150 students this week.

Out of the 94 kids screened last spring, researchers discovered seven with previously undetected heart conditions, two of which were potentially life-threatening and required surgery.

This incidence of heart conditions, nearly 7 percent for this group, is much higher than researchers anticipated.

"The adjective I would use to describe it is shocking," said Higgins. "Based on the literature, we [predicted] an incidence of about one in 200, but we [continue to get] higher than that number." Higgins says one reason for the seeming increase is that past screenings were limited to student athletes.

"We think the children who have these problems might be [those] who get more out of breath and can't keep up. By having this underlying problem, they might be [selected] out from high level athletics."

Higgins' HEARTS Saving Hearts

Even more compelling than the numbers, Higgins says, is that none of the kids showed outward symptoms at the time of screening and, hence, would have gone undiagnosed and untreated, possibly until it was too late.

"We had 10 sudden cardiac arrests in children last year [in Houston], and these children all had... conditions that would have been detected by our screening" but were not detected by routine checkups.

Higgins says he hopes this research will make a case for the need in the United States of routine pediatric heart screenings. If there is funding, he says he would like to use his research in Texas "as a springboard for the rest of the country."

Screening Is Helpful, But At What Cost?

In other countries, heart screening is an accepted practice in kids.

In Italy, a nationalized program of pediatric heart screening has reduced sudden cardiac death in Italian children, said Dr. Cam Patterson, director of the McAllister Heart Institute at the University of North Carolina.

In 2009, 25,000 Taiwanese kids in first, fourth and sixth grades were screened and 292 were diagnosed with heart problems. More than 60 percent of the problems had been unknown before the electrocardiogram testing.

This type of screening for kids in the U.S. has been proposed in the past, but cost has always been the primary deal breaker.

"There is no doubt that screening programs in children identify cardiac problems and save lives," said Patterson.

"The only argument against [it] is based on cost...there is no doubt that such programs would be extremely expensive...it could cost about $1,000 to screen each child."

But Higgins' research offers hope of a more cost effective way of screening kids.

Screening May Not Be the Best Way, Experts Say

The heart screening used by HEARTS involves a short questionnaire on patient history, a physical examination targeted at heart health, an EKG and a 5-minute modified echocardiogram.

The whole screening takes 15 minutes, Higgins says, and only costs $150 per patient.

But even so, the price of a nationwide pediatric heart screening program would be considerable. Some doctors say it may not be the best use of health care dollars.

"We are not good enough at screening to make this routine," said Dr. Brian Olshansky, director of Cardiac Electrophysiology at the University of Iowa. He says that screening will cause some kids to be identified as needing treatment -- even though any heart abnormalities they have may be harmless.

In these cases, "an intervention would actually create more harm than good," he said.

Dr. Barry Love, assistant professor of pediatric surgery at Mount Sinai, agreed, saying, "finding the very small number of children who would have died suddenly...has the unintended consequence of excluding a large number of children from healthy sports participation."

"We already have an epidemic of obesity and sedentary lifestyle in this country. Screening would make this worse," Love said.

Dr. Steve Nissen, chair of cardiovascular medicine at the Cleveland Clinic, doesn't feel that Higgins' screening would be wise to apply widely.

Instead, he favors physical exams to try to "uncover the subgroup with a high likelihood of abnormalities [for] further diagnostic testing."

Can We Put A Price on Young Lives?

Experts do agree, however, that something should be done about pediatric heart health.

"[Even] if the cost is prohibitive, the problem doesn't go away," Patterson said. "We need to find cheaper ways to screen children for heart problems, especially for low-income families where heart risk is highest and access to medical care is lowest."

Dr. Douglas Zipes, editor in chief of HeartRhythm, says that even with an imperfect, costly system, the potential to save children's lives makes screening worthwhile.

"I don't think you can put a dollar sign on young lives," Zipes said. "Even if it is inefficient and costly, it should be done."

And the parents of children who will gain a new lease on life and longevity as a result of Higgins' work would agree.

"It's a great thing that we have this technology and we are able to screen kids," said Shana Harvey, Madelinne's mother. "It's such a blessing that we were able to catch this."