Clinical Scorecard: Evaluating the Role of Cardiac Screening Before Athletic Participation: An Untapped Opportunity?

At a Glance

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

References

• Pre-participation screening in competitive athletes in Italy: an analysis of real-world practice from a large database