September 15th, 2014
No Endorsement for Routine ECG Screening of Young People
In a new scientific statement the American Heart Association and the American College of Cardiology do not recommend the routine initial use of ECGs to screen young people for underlying congenital or genetic heart disease.
More aggressive screening for heart disease in young people is often advocated in response to pressure resulting from the rare but tragic cases of sudden death in young people. But a detailed examination of the evidence led the AHA/ACC group to conclude that routine initial ECG screening “in healthy people 12-25 years old without positive findings on the history and physical examination has not been shown to save lives.”
The expert committee recommends that healthcare providers screen young people using a 14-point checklist that contains information taken from the personal history, family history, and physical examination of people aged 12 to 25. A positive finding on any of the 14 points means that further testing, including a 12-lead ECG, may be indicated.
“Although sudden death among young people is rare, it is always a tragedy, and the infrequency of these events in no way mitigates their importance or impact on families and the community. However, the media coverage of sudden cardiac arrests in athletes may have created the exaggerated impression that these tragic events are far more common than they actually are, or that they are limited to athletes,” said Barry Maron, a co-chair of the writing panel, in a press release.
The panel also stated that it found no evidence that sudden cardiac arrest was more likely to occur in young athletes than in the general population of young people. Because there are many more non-athletes than athletes, most deaths occur in young people taking part in recreational sports or everyday activities.
One important point, often unappreciated, is that ECGs are far from perfect and can result in both false-negative and false-positive results. These can lead to a mistaken reassurance of low risk or an excessive concern, perhaps leading to non-participation in sports in otherwise healthy young people. The panel estimated that routine ECG screening among only the 10 million young athletes in the U.S. (not the much larger general population) would result in 500,000 false-positive cases who would then undergo unnecessary additional testing.
The writing panel also noted that the overall cost of a mandatory screening program would be at least $2 billion a year initially and would require the development of a complex infrastructure. “Many individuals at high risk for sudden cardiac death could be found by more uniform application of careful history taking and a detailed physical examination (without an ECG) utilized in all,” they said.