Checking all young people with electrocardiograms or ECGs would not prevent more fatal heart problems, but routine physical exams and assessments of medical history could, a panel of heart experts said Monday.
The question of whether electrocardiograms should be mandatory for young athletes often arises after a young athlete dies from sudden cardiac arrest, but actually, all people ages 12-25 could benefit from routine health screenings, according to a new scientific statement from the American Heart Association and the American College of Cardiology. The group specifically examined the use of ECGs in that age group and published findings in the AHA journal Circulation.
“There just isn’t any evidence that the ECG is more valuable than patient health history and a physical exam, and there’s no evidence that ECGs save lives in a general healthy population,” said Barry J. Maron, M.D., chairman of the scientific statement writing group and director of the Hypertrophic Cardiomyopathy Center at the Minneapolis Heart Institute Foundation.
Heart events are extremely rare for young people, including athletes, but because they are so tragic and stunning it is natural for people to seek ways to prevent them.
“If your child has died of one of these [heart defects] that someone tells you could have been identified by an ECG, you’re understandably going to want to see something done,” Maron said.
However, research doesn’t support the use of ECGs — common tests in which electrodes attached to the body measure the heart’s electrical activity — as a widespread solution, according to the scientific statement.
ECGs do not always detect heart problems accurately because they are known to have “false positives,” meaning they suggest conditions that later turn out not to exist, and “false negatives,” meaning that some serious problems will be missed by an ECG. This accuracy problem, coupled with the scarcity of youth cardiac events, means ECGs are simply not an effective approach, Maron said. And even if the accuracy issues could be significantly reduced, ECGs would not be a practical lifesaving tool on such a massive scale, according to the statement. Maron said referring a young person for an ECG may be appropriate — and accurate — if the patient’s personal or family history or a physical exam suggest risk.
The American Heart Association’s panel recommends a standard 14-point screening for young people that includes asking about fainting, chest pain or excessive shortness of breath or fatigue during exercise; premature death or disability due to heart disease or known cardiac conditions involving the heart muscle or heart rhythm in family members; and also includes listening for heart murmurs and checking for other signs that indicate heart or blood vessel disease. The panel isn’t opposed to including ECGs in screening populations if quality control can be assured.
Survivors and victims’ families have varying opinions on ECGs.
The family of Quinn Driscoll thinks ECGs are worthwhile even if they’re not a surefire solution.
Quinn died while running on a track during gym class five years ago, shortly before his 14th birthday. His death was caused by hypertrophic cardiomyopathy, a common cause of cardiac arrest in young people, including athletes. Nothing had seemed wrong before then, his father Scott Driscoll said.
“The one and only symptom was that he died,” said Scott, who described Quinn as a humble, goofy kid. His parents have established the Quinn Driscoll Foundation in Vancouver, Washington, to advocate for cardiac screenings for kids, including ECGs, and to promote the importance of automated external defibrillators or AEDs in communities.
Driscoll said he thinks the added layer of safety is worthwhile, even though the screenings are sometimes inaccurate.
“Finding something inconclusive is better than the alternative,” Driscoll said. “That price is nothing compared to the price of losing a child.” And 90 percent of individuals with hypertrophic cardiomyopathy will have an abnormal ECG, according to the panel.
David Wilganowski was 17 when his heart stopped and he collapsed at a high school football game in Bryan, Texas.
He also advocates for ECGs even though several ECGs after his event didn’t reveal a problem.
“ECGs are not perfect, so you’re going to miss some things and get some false readings as well,” said Wilganowski, now a 20-year-old junior at Rice University. “But I think it’s definitely real positive and you could find something horribly wrong and save a person’s life.”
Lisa Salberg of Rockaway, New Jersey, learned she had hypertrophic cardiomyopathy after a murmur was detected during a school physical when she was 12. Even though she has lost seven family members to heart disease, she’s convinced that routine ECGs would not save more lives.
Salberg founded the Hypertrophic Cardiomyopathy Association and has worked as a patient advocate for more than 5,000 families with HCM. She favors comprehensive screenings for all youth, and says that those with risk factors should be seen by a cardiologist for a comprehensive evaluation.
“While it may sound easy to find hypertrophic cardiomyopathy with mass ECG screenings, this is sadly not the case,” said Salberg, who served on the writing committee of the scientific statement. “We have seen many false negatives resulting in deaths, and false positives resulting in over-testing and anxiety.”
She said identifying heart disease in a timely matter is key.
“We remain committed to finding the most scientifically valid methods to do that for all young people,” Salberg said.
The American Heart Association recommends many ways to help prevent and treat sudden cardiac deaths for all ages.
The association has long advocated for placing AEDs, or automated external defibrillators, in public places including schools. AEDs are an important lifesaving tool, and having them easily and quickly accessible is crucial.
The AHA is also working with lawmakers to make CPR training a high school graduation requirement in every state. So far, nearly 20 states have such laws on the books, which means more than 1 million students will finish high school with this lifesaving skill every year.