Calls to develop a new “CRY-teria” for screening elite athletes to avoid unnecessary disqualification.
A new study from researchers based at St George’s, University of London [funded by the charity, Cardiac Risk in the Young, CRY] and published in the leading journal Circulation1 has found that current European screening guidelines used by sports organisations to detect heart abnormalities lead to over-investigation and the potential false disqualification of black athletes with perfectly healthy hearts.
To protect the health of young athletes, many sports bodies now recommend or insist on cardiac screening for a number of heart disorders that can lead to sudden death but are easily detectable using an electrocardiogram (ECG) – a test that measures the electrical activity of the heart and detects abnormal heart rhythms.
However, this new research has found that the application of new screening criteria could reduce unnecessary investigations and potential disqualifications by around 30%.
Researchers, led by Clinical Research Fellow and Cardiology Registrar Dr Nabeel Sheikh, analysed the electrical activity of the heart using an ECG in 1208 black athletes, 4297 white athletes, and 103 athletes with hypertrophic cardiomyopathy, a condition where the heart muscle becomes thickened and the leading cause of sudden death in young athletes worldwide. The ECGs were compared using:
– current guidelines issued by the European Society of Cardiology (ESC),
– newly published Seattle criteria
– a set of proposed “refined criteria” that take into consideration novel research findings and the effect of black ethnicity.
Although the ESC’s screening guidelines, based predominately on data from white athletes, were revised in 2010 to reduce false positives, the researchers found that 40% of black athletes and 16.5% of white athletes participating in the clinical study would still be required to undergo further investigations under the ESC’s current guidelines.
The Seattle criteria reduced the number of positive ECGs to 18.4% in black athletes and 7.1% in white athletes.
However the researchers’ own refined criteria produced the greatest reduction: applying these new criteria reduced positive ECGs to 11.5% in black athletes and 5.3% in white athletes, without compromising the ECG’s ability to detect sinister cardiac pathology.
Dr Steve Cox, Director of Screening at CRY; “This study is a real milestone in our understanding of cardiac screening. We believe this new “CRY-teria”, developed by our funded research fellows, could help refine current ECG screening guidelines, whilst reducing the burden of false-positive results and number of athletes incorrectly suspected to harbour a serious cardiac disorder during pre-participation cardiac screening.”
“Whilst we are rightly focused on identifying and treating ‘at risk’ athletes, we must not under-estimate the impact of giving a professional athlete a false positive result, especially at the start of a promising a career, At the very least, this causes undue anxiety for them and their family but ultimately may also have a serious financial and social effect, as well as a lifetime of unnecessary screening and insurance implications for their family.”
Every week in the UK, 12 seemingly fit and healthy young people under the age of 35 die from sudden cardiac death. Many – although not all – of these young people were often involved in sport. 80% of those that die have no symptoms, so the only way to identify a problem is through screening.
In Italy, athletes undergo a unique mandatory state-sponsored cardiovascular screening programme that incorporates clinical history, physical examination and a 12-lead ECG. Data from this 30 year model has shown a fall in sudden cardiac death rates by 90%.
Lead author, Nabeel Sheikh, adds: “Our study shows that ethnicity must be taken into consideration during pre-participation screening if we want to avoid unnecessary investigations and false disqualification from sport. Our results also indicate that refining ECG criteria has a positive impact on not only black but also white athletes. It is therefore our hope that the data from our study will provide an important evidence base for revising existing guidelines in the future and significantly reduce the burden of false-positive ECGs.”
CRY’s acclaimed screening programme, which was first launched in 1995, now tests around 14,000 young people every year. It also forms part of a wider research programme that is building on understanding of the incidence of cardiac conditions in young people and informing national policy on best practice to minimise the incidence and impact of young sudden death.
1 Circulation 2014;129:1626-1628 – http://circ.ahajournals.org/content/early/2014/03/11/CIRCULATIONAHA.113.006179.abstract
ENDS
For more information about the published review in ‘Circulation’ or to request an interview please call Jo Hudson in the CRY Press Office on 020 7112 4905 / 0770 948 7959: jo.hudson@trinitypr/co.uk www.c-r-y.org.uk / www.testmyheart.org
Notes to editors:
CRY provides screening services for a number of professional sporting bodies including the English Institute of Sport, the RFU, RFL, LTA, a number of FA teams including Manchester City, and the vast majority of the Olympic Athletes (GB Rowing, GB Cycling, GB Swimming, GB Diving, UK Athletics).
As well as campaigning and lobbying and the provision of its subsidised cardiac screening programme for young people (35 and under), the charity also provides counselling support to bereaved families and young individuals who may be diagnosed.
Sudden Cardiac Death (SCD) is an umbrella term for a number of different heart conditions that affect fit and healthy people which, if not treated can result in a dramatic and or / spontaneous death. In about one in 20 cases of sudden cardiac death, no recognised cause can be found – even after post-mortem. This is then called Sudden Arrhythmic Death Syndrome (SADS).
