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Performance of the American Heart Association ( AHA ) 14-Point Evaluation Versus Electrocardiography for the Cardiovascular Screening of High School Athletes: A Prospective Study.
- Source :
-
Journal of the American Heart Association [J Am Heart Assoc] 2019 Jul 16; Vol. 8 (14), pp. e012235. Date of Electronic Publication: 2019 Jul 09. - Publication Year :
- 2019
-
Abstract
- Background Preparticipation cardiovascular screening in athletes is fully endorsed by major medical societies, yet the most effective screening protocol remains debated. We prospectively compared the performance of the American Heart Association ( AHA ) 14-point screening evaluation and a resting ECG for cardiovascular screening of high school athletes. Methods and Results Competitive athletes participating in organized high school or premier/select level sports underwent cardiovascular screening using the AHA 14-point history and physical examination, and an ECG interpreted with the Seattle Criteria. A limited echocardiogram was performed for all screening abnormalities. The primary outcome measure was identification of a cardiovascular disorder associated with sudden cardiac death. From October 2014 to June 2017, 3620 high school athletes (median age, 16 years; range 13-19; 46.2% female; 78.6% white, 8.0% black) were screened. One or more positive responses to the AHA 14-point questionnaire were present in 814 (22.5%) athletes. The most common history responses included chest pain (8.1%), family history of inheritable conditions (7.3%), and shortness of breath (6.4%). Abnormal physical examination was present in 356 (9.8%) athletes, and 103 (2.8%) athletes had an abnormal ECG . Sixteen (0.4%) athletes had conditions associated with sudden cardiac death. The sensitivity (18.8%), specificity (68.0%), and positive predictive value (0.3%) of the AHA 14-point evaluation was substantially lower than the sensitivity (87.5%), specificity (97.5%), and positive predictive value (13.6%) of ECG . Conclusions The AHA 14-point evaluation performs poorly compared with ECG for cardiovascular screening of high school athletes. The use of consensus-derived history questionnaires as the primary tool for cardiovascular screening in athletes should be reevaluated.
- Subjects :
- Adolescent
American Heart Association
Aortic Diseases complications
Aortic Diseases diagnosis
Cardiomyopathy, Hypertrophic complications
Cardiomyopathy, Hypertrophic diagnosis
Cardiovascular Diseases complications
Cardiovascular Diseases physiopathology
Chest Pain physiopathology
Coronary Vessel Anomalies complications
Coronary Vessel Anomalies diagnosis
Death, Sudden, Cardiac etiology
Dyspnea physiopathology
Echocardiography
Female
Humans
Long QT Syndrome complications
Long QT Syndrome diagnosis
Male
Mass Screening methods
Medical History Taking
Physical Examination
Predictive Value of Tests
Prospective Studies
Sensitivity and Specificity
Surveys and Questionnaires
Syncope physiopathology
United States
Wolff-Parkinson-White Syndrome complications
Wolff-Parkinson-White Syndrome diagnosis
Young Adult
Athletes
Cardiovascular Diseases diagnosis
Death, Sudden, Cardiac prevention & control
Electrocardiography
Students
Subjects
Details
- Language :
- English
- ISSN :
- 2047-9980
- Volume :
- 8
- Issue :
- 14
- Database :
- MEDLINE
- Journal :
- Journal of the American Heart Association
- Publication Type :
- Academic Journal
- Accession number :
- 31286819
- Full Text :
- https://doi.org/10.1161/JAHA.119.012235