Pre-participation screening for hypertrophic cardiomyopathy in young athletes
Abstract
Aims:
This literature review seeks to explore the efficacy of pre-participation screening (PPS) in identifying hypertrophic cardiomyopathy (HCM) and preventing sudden cardiac death (SCD) in young athletes within the UK.
Background:
SCD accounts for half of all cardiovascular mortality in persons under 30 years and HCM is the leading cause of exercise-related cardiovascular death in young athletes. Substantial interest persists regarding the effectiveness of PPS and the necessity for universal legislation and implementation.
Findings:
PPS of young athletes identified HCM (and other cardiovascular disease) that could have prevented SCD. Electrocardiography (ECG) had virtuous impact when included within PPS. However, echocardiography—noted as gold standard assessment of HCM—was largely insignificant. SCD had greater prevalence in males than females, yet there was significant ethnic underrepresentation. PPS lacked consistency.
Conclusion:
PPS is universally divisive and present legislative application in the UK remains unfounded. There is evidence highlighting the efficacy of PPS identifying HCM (and other cardiovascular disease), and thus preventing SCD in young athletes. ECG inclusion could have benefits in PPS. However, further studies targeting age, sex, ethnicity, cost analysis and consistency are imperative before PPS is mandated.
Relevance to clinical practice:
Essential practical, psychological and ethical implications govern PPS implementation, illustrating expert clinical nursing support and prospective intervention in SCD aftermath.
References
-
American Heart Association (2012) Preparticipation Cardiovascular Screening of Young Competitive Athletes: Policy Guidance. http://tinyurl.com/qavg8yu (accessed 15 October 2014 ) Google Scholar - 2010) Cardiovascular screening in college athletes with and without electrocardiography: A cross-sectional study. Ann Intern Med 152(5): 269–75. doi: https://doi.org/10.7326/0003-4819-152-5-201003020-00004 Crossref, Google Scholar (
- 2008) Prevalence of hypertrophic cardiomyopathy in highly trained athletes: relevance to pre-participation screening. J Am Coll Cardiol 51(10): 1033–9. doi: https://doi.org/10.1016/j.jacc.2007.10.055 Crossref, Google Scholar (
-
British Cardiovascular Society (2012) Pre-participation screening for athletes in the UK. http://tinyurl.com/or24gyg (accessed 15 October 2014 ) Google Scholar -
British Heart Foundation (2013) Hypertrophic Cardiomyopathy. www.bhf.org.uk/heart-health/conditions/cardiomyopathy/hypertrophic-cardiomyopathy.aspx (accessed 2 October 2014 ) Google Scholar -
Cardiac Risk in the Young (2013a) Statistics. www.c-r-y.org.uk/statistics.htm (accessed 2 October 2014 ) Google Scholar -
Cardiac Risk in the Young (2013b) Why introduce a screening programme? www.c-r-y.org.uk/why_should_we_introduce_an_ecg_p.htm (accessed 2 October 2014 ) Google Scholar - 2007) An electrocardiogram should not be included in routine preparticipation screening of young athletes. Circulation 116(22): 2610–4 Crossref, Google Scholar (
- 2013) Sudden cardiac death in young athletes: practical challenges and diagnostic dilemmas. J Am Coll Cardiol 61(10): 1027–40. doi: https://doi.org/10.1016/j.jacc.2012.08.1032 Crossref, Google Scholar (
- 2005) Cardiovascular pre-participation screening of young competitive athletes for prevention of sudden death: proposal for a common European protocol: Consensus Statement of the Study Group of Sport Cardiology of the Working Group of Cardiac Rehabilitation and Exercise Physiology and the Working Group of Myocardial and Pericardial Diseases of the European Society of Cardiology. Eur Heart J 26(5): 516–24 Crossref, Google Scholar (
- 2006) Trends in sudden cardiovascular death in young competitive athletes after implementation of a preparticipation screening program. JAMA 296(13): 1593–601 Crossref, Google Scholar (
- 2010) Recommendations for interpretation of 12-lead electrocardiogram in the athlete. Eur Heart J 31(2): 243–59. doi: https://doi.org/10.1093/eurheartj/ehp473 Crossref, Google Scholar (
- 2012) Sudden cardiac death in athletes: What is the role of screening? Curr Opin Cardiol 27(1): 41–8. doi: https://doi.org/10.1097/HCO.0b013e32834dc4cb Crossref, Google Scholar (
- 2013) Pros and cons of screening for sudden cardiac death in sports. Heart 99(18): 1365–73. doi: https://doi.org/10.1136/heartjnl-2012-302160 Crossref, Google Scholar (
- 2011) Risk of sports: do we need a pre-participation screening for competitive and leisure athletes? Eur Heart J 32(8): 934–44. doi: https://doi.org/10.1093/eurheartj/ehq482 Crossref, Google Scholar (
- 2013) The government must change their policy on cardiac screening in young people (e-petition). http://epetitions.direct.gov.uk/petitions/31819 (
accessed 2 October 2014 ) Google Scholar ( - 2014) ECG Screening is not warranted for the recreational athlete. J Am Coll Cardiol 63(19): 2035–6. doi: https://doi.org/10.1016/j.jacc.2014.01.045 Crossref, Google Scholar (
- 2009) Aetiology of sudden cardiac death in athletes in the United Kingdom: a pathological study. Heart 95(17): 1409–14. doi: https://doi.org/10.1136/hrt.2009.168369 Crossref, Google Scholar (
-
Department of Health (2013) Get active to get healthy (press release). www.gov.uk/government/news/get-active-to-get-healthy (accessed 2 October 2014 ) Google Scholar - 2006) Historical trends in reported survival rates in patients with hypertrophic cardiomyopathy. Heart 92(6): 785–91 Crossref, Google Scholar (
- 2009) Public health implications of establishing a national programme to screen young athletes in the UK. Br J Sports Med 45(7): 576–82. doi: https://doi.org/10.1136/bjsm.2009.061184 Crossref, Google Scholar (
- 2011) Predicting and preventing sudden cardiac death. Circulation 124(5): 651–6. doi: https://doi.org/10.1161/CIRCULATIONAHA.110.974170 Crossref, Google Scholar (
-
European Society of Cardiology (2012) ACC/AHA/ESC 2006 guidelines for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. http://tinyurl.com/ncqspmz (accessed 15 October 2014 ) Google Scholar - 2012) 78 minutes in the life (and near death) of Fabrice Muamba. The Guardian www.theguardian.com/football/2012/mar/25/muamba-collapse-minute-by-minute (
accessed 2 October 2014 ) Google Scholar ( - 2000) Cost effectiveness analysis of screening of high school athletes for risk of sudden cardiac death. Med Sci Sports Exerc 32(5): 887–90 Crossref, Google Scholar (
- 2007) Preparticipation medical evaluation in professional sport in the UK: theory or practice? Br J Sports Med 41(12): 890–6 Crossref, Google Scholar (
- 2009) Notes of the UK National Screening Committee Stakeholder Meeting on Screening for Sudden Cardiac Death in Young People. www.screening.nhs.uk/policydb_download.php?doc=112 (
accessed 3 October 2014 ) Google Scholar ( - 2007) Cardiac Nursing: A comprehensive guide (2nd edn). London: Churchill Livingstone. Google Scholar (
- 2007) Sudden cardiac death in young athletes: time for a Nordic approach in screening. Scand J Med Sci Sports 18(2): 132–9. doi: https://doi.org/10.1111/j.1600-0838.2007.00749.x Crossref, Google Scholar (
- 2010) Pre-participation cardiac screening in young athletes: Models and criteria. British Journal of Cardiac Nursing 5(9): 426–31 Link, Google Scholar (
- 2005) Cardiology. 8th edn. Elsevier Saunders, London Google Scholar (
- 2008) Who will pay? www.bmj.com/rapid-response/2011/11/02/who-will-pay (
accessed 3 October 2014 ) Google Scholar ( - 2009) Acute Cardiac Care : A Practical Guide for Nurses. Wiley-Blackwell, Sussex Google Scholar (
- 2003) Relationship of race to sudden cardiac death in competitive athletes with hypertrophic cardiomyopathy. J Am Coll Cardiol 41(6): 974–80 Crossref, Google Scholar (
- 2006) The heart of trained athletes: cardiac remodeling and the risks of sports, including sudden death. Circulation 114(15): 1633–44 Crossref, Google Scholar (
- 2007) Recommendations and considerations related to preparticipation screening for cardiovascular abnormalities in competitive athletes: 2007 update: a scientific statement from the American Heart Association Council on Nutrition, Physical Activity, and Metabolism: endorsed by the American College of Cardiology Foundation. Circulation 115(12): 1643–455 Crossref, Google Scholar (
- 2009) Sudden deaths in young competitive athletes: analysis of 1866 deaths in the United States, 1980-2006. Circulation 119(8): 1085–92. doi: https://doi.org/10.1161/CIRCULATIONAHA.108.804617 Crossref, Google Scholar (
- 2010) National electrocardiography screening for competitive athletes: Feasible in the United States? Ann Intern Med 152(5): 324–6. doi: https://doi.org/10.7326/0003-4819-152-5-201003020-00012 Crossref, Google Scholar (
- 2013) Incidence of cardiovascular sudden deaths in Minnesota high school athletes. Heart Rhythm 10(3): 374–7. doi: https://doi.org/10.1016/j.hrthm.2012.11.024 Crossref, Google Scholar (
- 2006) The diagnosis and management of hypertrophic cardiomyopathy. British Journal of Cardiac Nursing 1(5): 225–31 Link, Google Scholar (
- 2013) The Oliver King Foundation – SADS (e-petition). http://epetitions.direct.gov.uk/petitions/29399 (
accessed 3 October 2014 ) Google Scholar ( - 2010) Preparticipation screening and prevention of sudden cardiac death in athletes: implications for primary care. J Am Acad Nurse Pract 24(2): 63–9. doi: https://doi.org/10.1111/j.1745-7599.2011.00694.x Crossref, Google Scholar (
- 2007) Electrocardiograms should be included in preparticipation screening of athletes. Circulation 116(22): 2616–26 Crossref, Google Scholar (
- 2005) Gender-related differences in the clinical presentation and outcome of hypertrophic cardiomyopathy. J Am Coll Cardiol 46(3): 480–7 Crossref, Google Scholar (
- 2009) Sudden cardiac death risk in hypertrophic cardiomyopathy. Eur Heart J 30(21): 2558–9. doi: https://doi.org/10.1093/eurheartj/ehp307 Crossref, Google Scholar (
- 2013) The nurse's role in diagnosing hypertrophic cardiomyopathy. British Journal of Cardiac Nursing 8(8): 388–393 Link, Google Scholar (
- 2008) Preparticipation screening for cardiovascular abnormalities in young competitive athletes. BMJ 337: a1596. doi: https://doi.org/10.1136/bmj.a1596 Crossref, Google Scholar (
- 2009) The magnitude of sudden cardiac death in the young: a death certificate-based review in England and Wales. Europace 11(10): 1353–8. doi: https://doi.org/10.1093/europace/eup229 Crossref, Google Scholar (
- 2006) Evidence for efficacy of the Italian pre-participation screening programme for identification of hypertrophic cardiomyopathy in competitive athletes. Eur Heart J 27(18): 2196–200 Crossref, Google Scholar (
- 1996) Athlete's heart in women. Echocardiographic characterization of highly trained female athletes. JAMA 276(3): 211–5 Crossref, Google Scholar (
-
Prime Minister's Office, 10 Downing Street (2013) Olympic legacy boost: £150 million for primary school sport in England (press release). www.gov.uk/government/news/olympic-legacy-boost-150-million-for-primary-school-sport-in-england (accessed 3 October 2014 ) Google Scholar - 2012) Sudden cardiac death among competitive adult athletes: a review. Postgrad Med J 88(1041): 382–90. doi: https://doi.org/10.1136/postgradmedj-2011-130215 Crossref, Google Scholar (
- 2008) Hypertrophic cardiomyopathy: etiology, diagnosis, and treatment. Cardiol Rev 16(4): 172–80. doi: https://doi.org/10.1097/CRD.0b013e318178e525 Crossref, Google Scholar (
- 2011) Screening young people at risk of sudden cardiac death. British Journal of Healthcare Assistants 5(2): 96–7 Link, Google Scholar (
- 2013) Systematic echocardiography is not efficacious when screening an ethnically diverse cohort of athletes in West Asia. Eur J Prev Cardiol doi: https://doi.org/10.1177/2047487313506549. Google Scholar (
- 2012) Structural cardiac disease diagnosed by echocardiography in asymptomatic young male soccer players: implications for pre-participation screening. Br J Sports Med 46(5): 371–3. doi: https://doi.org/10.1136/bjsm.2011.085696 Crossref, Google Scholar (
- 2006) Sudden cardiac death in the young: a strategy for prevention by targeted evaluation. Cardiology. 105(4): 196–206 Crossref, Google Scholar (
- 2012) Raising awareness of the need for cardiac pre-participation screening in young athletes. British Journal of Cardiac Nursing 7(2): 71–4 Link, Google Scholar (
- 2011) Mandatory electrocardiographic screening of athletes to reduce their risk for sudden death proven fact or wishful thinking? J Am Coll Cardiol Vol. 57(11): 1291–6. doi: https://doi.org/10.1016/j.jacc.2010.10.037 Crossref, Google Scholar (
- 2010) Hypertrophic cardiomyopathy and sudden cardiac death. World J Cardiol 2(9): 289–98. doi: https://doi.org/10.4330/wjc.v2.i9.289. Crossref, Google Scholar (
-
UK National Screening Committee (2008) Hypertrophic Cardiomyopathy. The UK NSC policy on Hypertrophic Cardiomyopathy (HCM) screening in teenagers. www.screening.nhs.uk/hcm (accessed 3 October 2014 ) Google Scholar - 2011) Ethical Issues in Genetics. J Paediatr Child Health 47(9): 668–71. doi: https://doi.org/10.1111/j.1440-1754.2011.02168.x Crossref, Google Scholar (
- 2007) Efficacy of personal symptom and family history questionnaires when screening for inherited cardiac pathologies: the role of electrocardiography. Br J Sports Med 42(3): 207–11 Crossref, Google Scholar (
- 2002) Sudden cardiac death in 15–35 year olds in Sweden during 1992–99. J Intern Med 252(6): 529–36 Crossref, Google Scholar (