Clinical Report: Diagnostic Yield and Cost of Cardiac Screening in Competitive Athletes
Overview
Preparticipation cardiac screening (PPS) in over 61,000 Italian competitive athletes revealed a 7.6% rate of second line evaluations and a 0.34% prevalence of high-risk cardiovascular conditions, increasing with age. Costs of screening were age-dependent, ranging from €60 in younger athletes to €107 in those aged 35 and older.
Background
Preparticipation screening (PPS) aims to identify underlying cardiovascular disease in competitive athletes to prevent adverse events. Despite broad recommendations, controversies remain regarding screening methods, timing, target populations, and the impact on cardiovascular outcomes. Data-driven insights are limited, making real-world screening analyses crucial for refining PPS protocols and resource allocation.
Data Highlights
Parameter
Value
Total PPS examinations
111,062
Number of athletes
61,731
Male athletes
~69%
Age distribution
47% ≤18 years, 31% 19–34 years, 21% ≥35 years
Second line evaluation rate
7.6%
High-risk cardiovascular condition prevalence
0.34% overall (0.12% young athletes to 1.19% Masters athletes)
Abnormal ECG rate variability among physicians
0% to 7.1%
Cost of PPS and second line evaluation
€60 (young athletes) to €107 (≥35 years)
Key Findings
7.6% of athletes required second line cardiovascular evaluation after initial PPS.
High-risk cardiovascular conditions were identified in 0.34% of athletes, with prevalence increasing with age.
Considerable variability existed in abnormal ECG detection rates among physicians (0% to 7.1%).
Medical history and physical examination accounted for the majority of abnormal PPS findings, more so than ECG.
Costs of screening and follow-up were age-dependent, lowest in younger athletes and highest in those ≥35 years.
Limitations include lack of data linking abnormal tests to final diagnoses, preventing assessment of test sensitivity and specificity.
Clinical Implications
These findings support the value of structured PPS including history, physical exam, ECG, and exercise testing to identify at-risk athletes, especially as age increases. However, variability in test interpretation and unclear diagnostic accuracy highlight the need for standardized protocols and further research. Cost considerations suggest that integrating sports medicine physicians in screening may reduce expenses but require balancing with quality assurance.
Conclusion
This large real-world study underscores the diagnostic yield and resource implications of cardiac screening in athletes, emphasizing the importance of ongoing evaluation and refinement of PPS strategies to optimize clinical benefit and cost-effectiveness.
