Heart screening: What about young non-athletes?

By AMERICAN HEART ASSOCIATION NEWS

 

Preventing sudden cardiac deaths in young athletes is grabbing headlines as state legislatures and the NCAA tackle the issue with new urgency. But a big group of people is missing from the growing debate: young people who don’t participate in sports, and who die from cardiac arrest in numbers far higher than athletes.

One study estimated about 66 young athletes ages 13 to 25 die from cardiac arrest each year, while other research suggests eight times as many non-athletes are also dying.

“Exercise increases the risk of sudden cardiac death if you have an underlying heart abnormality, whether you’re an athlete or not,” said Paul D. Thompson, M.D., chief of cardiology at Hartford Hospital in Connecticut. More exercise means more risk, especially for the much more active competitive athletes, he said.

Mentioning sudden cardiac arrest and young people may instantly trigger thoughts of the local high school athlete who died or national stars like Hank Gathers and Reggie Lewis, both of whom died on the basketball court. These shocking and often very public deaths are covered by the media and have given society the impression that such events are limited to athletes, Thompson said.

Figuring out how to prevent cardiac deaths in athletes has led some advocates to call for screening with electrocardiograms, or ECGs, a test that measures the electrical activity of the heart. Earlier this year, a bill that would have required ECGs for high school athletes in Texas passed the House but failed to reach the Senate. The American Heart Association and American College of Cardiology oppose mandatory mass ECG screening for young athletes and non-athletes.

Experts caution that screening only athletes raises ethical questions.

“If you are going to screen, then you have to be fair in deciding who you screen,” said Arthur Caplan, Ph.D., director of medical ethics at NYU Langone Medical Center’s department of population health. “The case for screening only athletes is not convincing.”

What would be fair, he said, is to screen where there is a need. “Everything is relative. The people in the stands are more at risk for cardiac arrest than the people on the court,” Caplan said.

In May, New Jersey became the first state to pass legislation requiring doctors to screen for heart disease in young people during annual physicals. Starting Tuesday, healthcare professionals will be required to do a cardiac medical history and physical exam during wellness checks for youths under 20, regardless of whether they participate in competitive sports.

Charles Garbarino, M.D., has been a pediatrician in New Jersey for more than 30 years and doesn’t expect much to change. “Pediatricians have already been doing cardiac screens all these years,” he said. “There’s just more emphasis now to ask these pertinent questions.”

The New Jersey law requires doctors to use a cardiac health assessment developed by the American Academy of Pediatrics and various other professional organizations. For example, a child with a heart murmur or who has fainted during exercise would be referred to a pediatric cardiologist. The AHA and ACC recommend a similar cardiac medical history and physical exam for young healthy people.

Lisa Salberg, left, and her daughter Becca

show scars where their defibrillators are implanted.  

Photo courtesy of Lisa Salberg

It was a heart murmur during a school physical in seventh grade that led Lisa Salberg to be diagnosed with hypertrophic cardiomyopathy, a condition in which the heart muscle thickens. Salberg, now 47, has lost her sister, grandfather and others in her family to cardiac arrest caused by the heart disorder, which is often inherited. Going back a century, she counts at least 15 family members who have had the condition, including her 20-year-old daughter, Becca.

Salberg recalls having symptoms such as shortness of breath with exercise and occasional chest pain two years before her diagnosis.

“I just thought it was normal because how does a child know normal from abnormal? We’ve done nothing to educate them or their parents,” said Salberg of Rockaway Township, New Jersey.

As founder of the Hypertrophic Cardiomyopathy Association, Salberg worked to get the New Jersey legislation passed and is now working to do the same in New York, Oregon and other states.

Yet to date, no screening method — ECG or otherwise — has proven to save lives.

“Given the scarce public health resources, if you really want to help young people, you’ve got to focus on the major killers — drowning, suicide, car accidents, gun deaths,” said Caplan, who along with Thompson and Salberg helped to write the AHA/ACC guidelines on heart screening in young people.

“There’s certainly nothing wrong with doing a heart health assessment,” he said, “but that’s not a big problem for most kids.”