Athletes - Less Than 6% Of Doctors Follow Sudden Cardiac Death Screening Completely

Editor's Choice
Main Category: Sports Medicine / Fitness
Also Included In: Heart Disease;  Pediatrics / Children's Health
Article Date: 14 Nov 2011 - 16:00 PST


A very small percentage of doctors say they follow national sudden cardiac death screening guidelines completely when checking high school athletes. Sudden cardiac death is when the heart suddenly stops beating due to an arrhythmia (irregular heart rhythm). In fact, a considerable number of athletic directors and doctors do not even know the guidelines exist, researchers from Seattle Children's Hospital and the University of Washington School of Medicine, explained at the American Heart Association's Scientific Sessions, 2011.

Nicolas Madsen, M.D., M.P.H. and team carried out a study involving 317 high school athletic directors and 1,113 pediatricians and family doctors in the state of Washington.

They found that a mere 6% of athletic directors and less than half of all the doctors said they knew about the existence of the guidelines. Not one athletic director said his/her school insisted on a physical in order to adhere to the guidelines.

Dr. Nicolas Madsen said:

"A young person at the peak of physical prowess, dying without any warning - it's a shocking, tragic and potentially preventable death."

Approximately 1 in every 30,000 to 50,000 thousand athletes dies each year from sudden cardiac arrest (out of hospital) in the USA. The country has approximately 7 million high school athletes.

A 12-point sudden cardiac death screening guideline for athletes was published by the AHA (American Heart Association) in 1996. The guidelines include four physical exam elements and eight questions about the person's medical history. The doctor also checks the patient's blood pressure and listens to their heart.

2,190 questionnaires were sent to primary care physicians (family doctors), athletic directors and pediatricians over a two month period. Madsen said they were surprised at the higher response rate - from 56% to 75%. This means there was genuine interest in the subject.

Athletic directors were asked about what requirements for physicals existed in their school, while physicians had to answer questions regarding pre-sports physicals.

To work out levels of adherence to national guidelines, the investigators used regression analysis as well as some other techniques.

Doctors said they missed several important questions during their screenings:

• They said they didn't always ask about chest pain during exercise - 28%
• They said they didn't always ask about unexpected and unexplained fainting - 22%
• They said they didn't always ask about early death or family history - 26%
• They said they didn't always ask about a family history of heart disease - 67%

They identified a link between knowing the guidelines existed, as well as being familiar with their contents, and screening frequency. There was no significant variation in the study results regarding doctors' level of experience or specialty, or the location or size of the schools.

Madsen said:

"We need new directions to educate providers and improve policy requirements so patients can actually benefit from these national recommendations."

All those surveyed agreed there should be a statewide form incorporating national guidelines for screening. Madsen added that parents should ask schools and doctors if they are using a standardized form.



Sudden Cardiac Arrest simulation - CPR being administered in a US Navy practice session

Sudden Cardiac Death

Sudden cardiac arrest (SCA) and sudden cardiac death (SCD) have very similar meanings - in fact, the two terms are often used interchangeably. SCA refers to the heart stopping, while SCD is more frequently used when referring to the person dying - virtually all cases of SCD are caused by the heart stopping, hence their similar usage in language.

Sudden cardiac arrest is a medical emergency which is fatal if not treated straight away. The left ventricle of the heart stops contracting or does not contract adequately, causing circulatory failure throughout the body. Signs and symptoms include no heart sounds, no pulses that can be felt over most arteries, very severe hypotension (low blood pressure), rapid shallow breathing that soon progresses to no breathing (apnea), and loss of consciousness.

SCA is among the greatest of all medical emergencies. The patient rapidly suffers from tissue hypoxia (lack of oxygen) and multiple organ damage.

The majority of people who have SCA die from it - usually rapidly. Using a defibrillator can save the patient's life, as can CPR if emergency services arrive quickly.

Sudden Cardiac Death in Young Athletes

The sportsman or woman typically develops abrupt-onset ventricular tachycardia or fibrillation, and dies in the middle of a game or practice session, according to the Merck Manual. SCD is ten times more likely to affect males than females. The highest risk sports for SCDs are soccer in Europe and basketball and football (American football) in the USA.

The most common cause of SCD in young athletes is undetected hypertrophic cardiomyopathy. Also a sudden blow to the precordium (the portion of the body over the heart and lower chest) can raise the risk of sudden ventricular tachycardia or fibrillation (commotio cordis) - even when there is no cardiovascular disease or condition.

Written by Christian Nordqvist
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today

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