Evaluating Preparticipation Screening Protocols and Health Equity in College Athletes

Overview

Preparticipation cardiac screening in college athletes reduces sudden cardiac death (SCD) risk but raises concerns about health equity due to disparities in access and exclusion of non-athletes. While ECG combined with history and physical exam improves detection and cost-efficiency, variability in resources and systemic inequities challenge uniform implementation.

Background

Sudden cardiac death is the leading medical cause of death among college-age individuals, affecting athletes and non-athletes alike. Preparticipation screening aims to identify cardiac abnormalities to prevent SCD, with methods including history and physical exam (H&P), electrocardiography (ECG), and echocardiography. Despite improved sensitivity when combining ECG with H&P, screening programs face challenges such as false positives, costs, and unequal access influenced by socioeconomic and institutional factors. Structural racism and resource disparities further complicate equitable screening implementation across diverse collegiate populations.

Data Highlights

Key Findings

• Sudden cardiac death rates are similar among collegiate athletes and non-athletes, yet screening typically targets athletes only.
• The 14-point history and physical exam has low sensitivity for detecting cardiac abnormalities linked to SCD.
• Adding ECG to H&P significantly improves detection sensitivity and cost-efficiency but increases false positives requiring further evaluation.
• False positive rates decrease with expert ECG interpretation and updated criteria such as the Seattle criteria.
• Disparities in healthcare access, influenced by socioeconomic status and institutional resources, create inequities in screening availability and quality.
• Collegiate athletic programs with larger budgets provide more comprehensive medical care, potentially disadvantaging athletes at smaller or less affluent institutions.

Clinical Implications

Clinicians should recognize that while ECG-enhanced screening improves detection of cardiac abnormalities, equitable access remains a critical challenge. Screening protocols must consider resource availability and aim to include non-athlete populations at similar risk. Institutions should advocate for allocation of resources to underserved populations to reduce disparities in cardiac care and prevention.

Conclusion

Preparticipation cardiac screening is vital for preventing sudden cardiac death in college-age individuals but must be implemented with attention to health equity. Addressing systemic disparities and expanding screening beyond athletes can improve outcomes and fairness in cardiovascular care.

References

1. Author/Source/Year -- Evaluating the Effects of Preparticipation Screening Protocols on Health Equity Among College Athletes