CardioExchange Archive

CardioExchange, an NEJM practice community for medical professionals dedicated to improving cardiac patient care, was active from 2009 to 2015. CardioExchange fostered discussion between clinicians from across the globe.

November 26th, 2012

Model Finds High Cost for ECG Screening of Athletes

A national program of ECG screening for U.S. athletes would save almost 5,000 lives over 20 years but would cost more than $50 billion dollars, according to a paper published in the Journal of the American College of Cardiology. The advisability of routine ECG screening for athletes has divided the experts: currently the ESC recommends ECG screening while the American Heart Association does not.

Israeli investigators developed a cost-projection model using data from a retrospective Italian study and based on population data derived from high school and college athletic associations and expense assumptions from Medicare. Currently there are more than 8.5 million student athletes. Over 20 years, the investigators predicted that a national screening program would result in 170 million ECG screenings and, based on an estimated 2% disqualification rate, 3.4 million disqualifications. This would cost between $51 and $69 billion dollars and save 4,813 lives, yielding a cost per life saved in the range of $10.6 to $14.4 million.

In an accompanying editorial comment, Antonio Pelliccia takes issue with the cost assumptions in the paper and maintains that pre-participation screening “should be priced as a package of preventive medicine program” rather than the more expensive individual diagnostic testing. He acknowledges that this “will require a change in the cultural attitude and current medical policy” in the U.S.

In a statement, the ACC said that automatic external defibrillators (AEDs) can be life saving “if used quickly on stricken athletes.” However, although AEDs are now commonly placed at sports venues and other public places, they “are only effective if actually used” and bystanders are often afraid to use them. “AEDs are life-saving,” said Joanne Foody, in the ACC statement. “While many fear they may cause more harm than good, it is not the case.”

Categories: Prevention


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