To the Editor—Participation screening for athletes

Screening ECGs for young competitive athletes: it is complicated

PURPOSE OF REVIEW

The role of the ECG in preparticipation sports screening for adolescent athletes is a major area of controversy today. Sudden cardiac death, especially in a young seemingly healthy individual, is a tragic and highly publicized event, which is often surrounded by cries from the public and medical community to 'do something.'

RECENT FINDINGS

This emotional need to address these catastrophic events has led to over 4000 articles addressing the optimal way to screen the young athlete, as well as conflicting recommendations from the American Heart Association and the European Society of Cardiology, specifically in regards to inclusion of a screening ECG. This article will review the advances in the field over the last year, including the new guidelines on screening of the young athlete from the American Heart Association.

SUMMARY

This last year has seen several important additions to the controversy surrounding the use of the 12-lead ECG in the screening of the young athlete. Although improved ECG criteria have decreased the prevalence of false positives, the actual utility of this practice has not been tested in real clinical practice outside of a formal investigation.

Pre-participation screening for athletes and the role of advanced practice providers

Pre-participation screening of athletes for underlying cardiovascular disease is recommended by the AHA/ACC. However, vigorous debate continues as to whether the ECG should be used as part of a broad-based screening program. The AHA/ACC "do not support national mandatory screening ECGs of athletes, because the logistics, manpower, financial and resource considerations make such a program inapplicable to US". In an effort to address these impediments and to increase access for communities, we explore the use of advanced practice providers (Nurse Practitioners and Physician Assistants) in providing pre-participation screening to athletes with ECG interpretation. In the current healthcare environment with limited primary care resources, advanced practice providers are an important new element in improving access to care. Pre-participation screening with ECG interpretation is currently within an advanced practice provider's scope of practice. Emerging data shows that advanced practice providers perform care that is within acceptable patient care standards, safely, and cost effectively, compared to physician counterparts. To further improve pre-participation screening, a national education and certification program on 12-lead ECG interpretation is needed. Standardized screening tools and mass screening protocols that include screening ECGs for targeted athlete populations who are at high risk for SCD are needed. These recommendations are aimed at addressing some of the barriers raised by the AHA/ACC group to pre-participation screening with ECG.