Clinical Scorecard: Evaluating the Role of Cardiac Screening Before Athletic Participation: An Untapped Opportunity?
At a Glance
Category
Detail
Condition
Underlying cardiovascular disease in competitive athletes
Key Mechanisms
Preparticipation screening (PPS) including personal/family history, physical exam, resting ECG, submaximal exercise testing with ECG monitoring, and second line evaluations
Target Population
Competitive athletes across age spectrum (children to middle age)
Care Setting
Sports medicine centers within private healthcare system
Key Highlights
7.6% of athletes required second line cardiovascular evaluation after initial PPS
0.34% of PPS exams identified high-risk cardiovascular conditions, increasing with age
Considerable variability in abnormal ECG rates among physicians (0% to 7.1%) and age-dependent screening costs
Guideline-Based Recommendations
Diagnosis
PPS should include structured personal and family history, physical examination, resting 12-lead ECG, and submaximal exercise testing with continuous ECG monitoring
Second line evaluations (echocardiography, bicycle ergometry, 24-hour Holter monitoring) for athletes with suspicious findings on PPS
Management
Referral for additional third line testing when diagnostic uncertainty persists after PPS and second line evaluation
Monitoring & Follow-up
Continual reevaluation of PPS practices to ensure clinical benefit and resource optimization
Risks
Variability in screening interpretation and diagnostic yield may affect accuracy
Uncertain sensitivity and specificity of individual PPS components due to lack of linked diagnostic data
Patient & Prescribing Data
Competitive athletes aged ≤18 years to ≥35 years undergoing PPS in Italy
Screening yield and costs increase with age; basic clinical evaluation components contribute substantially to abnormal findings though their diagnostic value is unclear
Clinical Best Practices
Implement structured PPS protocols including history, physical exam, ECG, and exercise testing
Use second line cardiovascular testing selectively based on initial PPS findings
Recognize variability in physician interpretation and strive for standardized training
Continuously collect and analyze real-world data to refine screening strategies
Consider cost-effectiveness and resource utilization in designing PPS programs
