Too Few Doctors Screen Young Athletes for Hidden Heart Trouble

Study of Washington state physicians, high school officials shows not enough are asking the right questions

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SUNDAY, Nov. 13 (HealthDay News) -- Tragic stories appear in the media about seemingly healthy young athletes dying on the playing field due to an undetected heart problem.

In response, the American Heart Association (AHA) issued guidelines aimed at helping doctors and coaches detect these problems early on and prevent such senseless deaths.

But new research suggests that only a small percentage of physicians are heeding the guidelines.

In the study, presented Sunday at the AHA's annual meeting in Orlando, Fla., less than half of physicians and only 6 percent of high school athletic directors in Washington state were aware of the life-saving guidelines -- potentially leaving many young athletes at risk.

"There is a striking lack of compliance with these guidelines," said study lead author Dr. Nicolas Madsen, a pediatric cardiology fellow at Seattle Children's Hospital and the University of Washington School of Medicine.

There are currently more than 7 million high school athletes in the United States, and one out of every 30,000 to 50,000 of them will die each year from sudden cardiac death, according to the AHA. One main cause of sudden cardiac death in young athletes is hypertrophic cardiomyopathy, a condition in which the heart muscle becomes thickened. There are other causes as well, including potentially fatal heart rhythm abnormalities.

The AHA's screening guidelines call for eight specific medical-history questions and four key elements in a physical exam, all designed to help doctors understand whether an athlete is at risk. Specifically, doctors need to ask athletes about chest pain during exercise, unexplained fainting and their family history of heart disease or early death before clearing them to play.

The study's survey canvassed more than 1,100 pediatricians and family doctors, plus 317 high school athletic directors, all from Washington state. It found that less than 50 percent of doctors and just 6 percent of athletic directors even knew about the AHA screening guidelines, the researchers found. None of the athletic directors said their schools required physicals aimed at assessing an athlete's risk for sudden cardiac death.

The doctors who participated in the new study did support use of a standardized statewide form based on the AHA guidelines, Madsen said.

The study also found that many doctors are skipping some of the questions outlined in the AHA guidelines. For example, 28 percent failed to ask young athletes about whether or not they ever experienced chest pain during exercise, 22 percent didn't always ask about unexplained fainting, and 67 percent didn't ask about family history of heart disease. The physical exam also includes listening to the heart and measuring blood pressure levels.

One expert was disappointed by the study findings.

"Doctors are not asking the right questions or doing the proper physical exams," said American Heart Association President Dr. Gordon F. Tomaselli.

In other countries, such as Italy, doctors routinely use electrocardiograms (ECG or EKG) to measure the electrical activity in young athletes' hearts and weed out those who may be at risk for sudden death. These tests often yield false-positive results, but they may be important if an athlete has risks based on the AHA screening criteria, said Tomaselli, who is also chief of cardiology at Johns Hopkins University School of Medicine in Baltimore. "Doctors need to ask the right questions to determine who needs follow-up tests," he said.

Parents, too, can do their part to protect young athletes, he said. "Parents can and should be engaged with the doctors and coaches -- particularly if there is a concerning [medical] history," he said.

Still, these are very difficult conversations to have, noted Dr. Clyde W. Yancy, chief of cardiology at Northwestern University's Feinberg School of Medicine in Chicago.

"Bringing the subject up is difficult," he said. "Imagine the anxiety and anticipation of family members, and it can be very difficult to have a conversation that may result in saying 'you can't [play this sport],' " he said.

Research presented at meetings should be considered preliminary until published in a peer-reviewed medical journal.

SOURCES: Nicolas Madsen, M.D., pediatric cardiology fellow, Seattle Children's Hospital and University of Washington School of Medicine; Gordon F. Tomaselli, M.D., chief of cardiology, Johns Hopkins University, Baltimore, and president, American Heart Association; Clyde W. Yancy, M.D., chief of cardiology, Northwestern University Feinberg School of Medicine, Chicago; Nov. 13, 2011, presentation, American Heart Association annual meeting, Orlando, Fla.

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