Published research funded by the charity CRY is improving the way young people are screened and leading to significant cost savings
Important research funded by Cardiac Risk in the Young (CRY) is adding further weight to the argument that proactive cardiac screening is a cost-effective way of saving young lives. By using the screening criteria developed by CRY (the so-called, “CRY-teria”) the number of false positives will be significantly reduced – resulting in a staggering 21% reduction in the cost of heart screening and follow-up tests for young people.
The paper published in the prestigious medical journal, JACC (Journal of the American College of Cardiology*) shows that the UK National Screening Committee’s fears of false-positive rates and the cost of additional investigations should not be seen as an obstacle to the widespread implementation of electrocardiographic (ECG) screening of young athletes for cardiac disease – particularly at a grassroots level.
Until now, ECG screening costs have never been systematically assessed in a large cohort of athletes. However, finally, this much anticipated 4-year study of over almost 5,000 athletes demonstrated a reduction in false positives from 21.8% to 4.3%.1
Dr Steven Cox, Chief Executive of CRY says; “This study – the first of its kind – is really demonstrating to the medical community that contemporary ECG interpretation criteria are starting to bring down the cost of screening young people. Importantly, it also underlines the vital role of the ECG test – whether for screening or diagnostic purposes – to detect underlying cardiovascular conditions that can increase the risk for sudden cardiac death.”
Every week, 12 apparently fit and healthy young (aged 35 and under) people in the UK die from a previously undiagnosed heart condition. In 80% of cases, there will have been no signs or symptoms, which is why CRY believes proactive screening is so vitally important – now testing over 23,000 young people every year. Sport itself does not cause young sudden cardiac death but it can exacerbate an underlying condition, if not identified.
This new study by Dr Harshil Dhutia and the research team led by world expert Professor Sanjay Sharma at St George’s University, London, in collaboration with the London School of Economics, investigated the costs of ECG screening in athletes according to three, recognised standards:
- The 2010 European Society of Cardiology (ESC) Recommendations
- The Seattle Criteria” (a refined, interpretation criteria that was developed in 2012 by some of the world’s leading experts in sports cardiology and sports medicine at a convention in Seattle, Washington, to increase the specificity of pre-participation ECG screening among elite athletes)
- The refined ECG criteria (the CRY-teria evidence-based guidelines by CRY, published by Circulation in 2014)
*”Cost Implications of Using Different ECG Criteria for Screening Young Athletes in the United Kingdom”; Volume 68, Issue 7, August 2016:702-711
As part of the study, 4,925 previously unscreened athletes aged 14 to 35 years were prospectively evaluated from 2011–2014 with a medical history, physical examination and ECG (interpreted with the 2010 ESC recommendations).
Compared to the 2010 ESC recommendations, the refined criteria would have resulted in 50% reduction in the number of echocardiograms, 12% reduction in the number of exercise tests, 8% reduction in Holter monitors, and 18% reduction in the number of cardiac MRI scans that would need to be performed to confirm (or refute) the diagnosis of cardiac disease.
Consequently, screening with the refined criteria translates to a 21% cost reduction of cardiovascular screening2 of young athletes without compromising sensitivity to detect serious disease.
Indeed, 15 (0.3%) of the athletes were diagnosed with potentially life-threatening cardiac disease using all 3 criteria.
Editor in Chief of JACC, Dr Valentin Fuster, posted a 10-minute audio recording discussing the findings of the research paper, stating; “This study demonstrates a dramatic reduction in false positives in ECGs using the Seattle Criteria and more recent refined criteria…also demonstrating that ECGs and appropriate secondary testing can potentially be accomplished in a cost effective manner.”
Since CRY was founded in 1995 CRY has tested over 100,000 young people, resulting in 100s of potentially life-threatening conditions being identified – both among elite athletes and general public.
Professor Sanjay Sharma, CRY’s Consultant Cardiologist is the leading Sports Cardiologist in the UK, and recognised as one of the leading experts for young sudden cardiac death worldwide. He makes no charge for supervising the CRY screening programme so due to this support CRY is able to significantly subsidise the programme (costing between £35 and £50). Privately these tests could cost many hundreds of pounds.
Chief Executive of the charity Cardiac Risk in the Young, Dr Steven Cox, concludes; “Sudden cardiac death is one of the most common causes of death in young people and it is the leading cause of death in athletes during sport. There is a great shortage of expertise in the interpretation of an athlete’s ECG and there is currently a critical need for greater education in modern ECG interpretation that distinguishes normal physiological adaptations in athletes from abnormal findings suggestive of pathology.”
He adds; “Through our pioneering screening programme, CRY’s research teams have unrivalled access to clinical data that is allowing us to further international understanding of the causes of young sudden cardiac death in both athletes and the general population as well as developing the most accurate and cost-effective way of identifying these potentially fatal and often preventable conditions.
“This research not only brings down the cost of cardiac screening – it will also have a major impact on routine ECG investigations of young people conducted within the NHS. There is no doubt that the UK Screening Committee needs to sit up and take notice NOW and stop brushing the importance – and validity – of cardiac screening for young people under the carpet.”
Any person between the age of 14 and 35 can book an appointment online and, in 3 clicks, can register to have a free cardiac investigation overseen by a specialist. www.testmyheart.org As CRY receives no government funding this is only possible because of the incredible support CRY receives from communities throughout the UK to provide this free service to the public.