NEW YORK (Reuters Health), Sep 4 - A preparticipation athletic screening program introduced in Italy in 1982 has been successful in markedly reducing the incidence of sudden cardiovascular death in young competitive athletes, new research suggests.
Most of the reduction in mortality came from a drop in deaths due to cardiomyopathies, according to the report in the October 4 issue of the Journal of the American Medical Association.
The first-line screening evaluation involves a personal and family history, physical examination, and a 12-lead ECG, Dr. Gaetano Thiene, from the University of Padua in Italy, and colleagues note. If any of these indicate an increased risk of cardiovascular disease, additional tests may be ordered. Identified cardiovascular abnormalities are then treated according to standard guidelines.
The present study, which took place in the Veneto region of Italy from 1979 through 2004, focused on athletes and nonathletes between 12 and 35 years of age.
During the study period, the annual rate of sudden cardiovascular death among athletes fell from 3.6 to 0.4 deaths per 100,000 person years. The drop in this rate began when the screening program was introduced and persisted into later years. By contrast, the death rate did not change in the unscreened nonathletic population.
As noted, the drop in cardiovascular mortality with screening was largely related to fewer cardiomyopathy deaths. Such deaths dropped from 1.5 to 0.15 per 100,000 person years during the study period.
In a separate analysis, the researchers looked at the percentage of athletes who were disqualified from competitive sports due to cardiovascular causes in 1982-1992 compared with 1993-2004. Data from 42,386 athletes were included in the analysis.
Overall, the percentage of athletes disqualified for cardiovascular reasons was nearly the same during the two periods, roughly 2%. However, the percentage disqualified for cardiomyopathies, in particular, climbed from 4.4% to 9.4% (p = 0.005).
In a related editorial, Dr. Paul D. Thompson, from the Hartford Hospital in Connecticut, and Dr. Benjamin D. Levine, from the University of Texas Southwestern Medical Center in Dallas, comment that the present study "provides the best evidence to date supporting the preparticipation screening of athletes and provocative evidence for including ECGs in this process."
JAMA 2006;1593-1601,1648-1650.
Last Updated: 2006-10-03 16:00:25 -0400 (Reuters Health)
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Playing their hearts out: Do young athletes need cardiac screening?, August 16, 2005
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