Teen athletes often not screened for heart risks, study finds

By Linda Carroll

Teen athletes at risk for sudden cardiac death may be falling through the cracks because doctors are skipping parts of screening exams, a new study shows.

In pre-season physicals for high school sports, fewer than 6 percent of doctors followed the potentially life-saving screening guidelines suggested by the American Heart Association, according to a report presented at the Heart Association’s annual meeting.

While doctors typically listen to young athletes’ hearts and record blood pressures, they often fail to ask important questions designed to ferret out heart disease risk. For example, 67 percent of surveyed doctors said they didn’t always ask teens whether any family members suffered from heart problems.

Even more alarming – barely half of the physicians were even aware that the AHA guidelines existed.

More than 7 million teens play high school sports, according to Dr. Nicolas Madsen, a cardiology fellow at Seattle Children’s Hospital of the University of Washington. Studies show that sudden death occurs at a rate of one in 30,000 to 40,000. That translates into 175 to 233 deaths each year among high school athletes.
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Recently, there’s been a push to add more tests, such as electrocardiograms, to the standard student-athlete physical, said Madsen, the study’s lead author. But we can’t know whether those additional tests are necessary until all physicians are following current guidelines to the letter, Madsen added.

For the new study Madsen and his colleagues sent out surveys to every family practice doctor and every pediatrician in Washington State. The response was high with 72 percent of pediatricians and 56 percent of family practitioners returning surveys.

Doctors did most poorly when it came to asking about the heart health of teens and their families.

28 percent didn’t always ask if a teen had chest pain during exercise
22 percent didn’t always ask if the teen ever experienced unexplained fainting
26 percent didn’t always ask about a family history of early deaths
67 percent didn’t always ask about a family history of heart disease.

While it’s heartening to see that most doctors did remember to ask about sudden deaths in a teen’s family, it’s distressing to see that more than two thirds of doctors weren’t always asking about a family history of heart disease in their exams, Madsen said.

That means that doctors could be missing families in which there were recognized heart problems, but no one had died.

For Dr. Gaurav Arora the biggest surprise in the new study was the number of physicians who said they didn’t always ask about chest pain or fainting.

“Those are red flags in young athletes,” said Arora, associate director of electrophysiology at the Children’s Hospital of Pittsburgh and an assistant professor of pediatrics at the University of Pittsburgh.

One explanation for the new findings is that there is no single form being used by doctors doing pre-season physicals for student athletes, Arora said. Things would be a lot simpler if everyone used the same screening criteria.

Beyond that, Arora said, “we need better education across the board for all providers doing screening.”

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