Headlines
As reported on ABC News, November 7, 2006.
Study: Italian Screening Program Reduces Sudden Cardiac Deaths
By Ryan Stanton
Ryan Owens, 16, and a lineman on the Henderson County High School
football team in Henderson, Ky., went to football practice last month.
After practice, he collapsed and shortly died. The death came as a shock
to the people of Henderson. Owens died of an unusual heart rhythm,
brought on by heat and an undiagnosed heart problem. He never had
any symptoms prior to his collapse.
Deaths like this are a parent's worst nightmare, but unfortunately, his
case is not unique. About 335,000 people a year die of coronary
heart disease before being admitted to a hospital or even making it to
an emergency room, according to the American Heart Association.
Health officials call this Sudden Cardiac Death or SCD. Most victims
are older, but a few cases involve young athletes, who appear to be in
the peak of physical health and have no symptoms of impending doom.
SCD is a phenomenon that is seen worldwide in which a previously healthy
person has some form of heart problem that leads to sudden death.
Most of these are related to a class of heart problems known as
cardiomyopathies in which the heart muscle is diseased, leading to pump
and rhythm problems.
In the United States, there have been numerous high-profile SCD cases
involving young athletes:
In 2005, NFL lineman Thomas Herrion died following a preseason game.
Herrion collapsed in the locker room and was transported to a hospital
in Denver where he was pronounced dead.
In 1993, Reggie Lewis, a Boston Celtics basketball star, died during a
pickup basketball game.
Skater Sergei Grinkov collapsed and died on the ice during a practice in
1995.
NBA center Jason Collier died in 2004 of an enlarged heart that his
family said he was unaware of. Since Collier's death, the NBA has
instituted mandatory cardiac screening for its players.
The National Federation of State High School Associations estimates 10
SCD cases to 25 SCD cases per year in individuals younger than 30 years
in the United States.
In 1982, Italy implemented a program to try and reduce SCDs by
performing screening on all 12- to 35-year-olds who planned to
participate in any strenuous competitive sport.
The program uses family history, personal history, a physical exam
and an ECG to determine risk of SCD. No analysis had ever been
performed to see whether the program had actually made a difference,
until now.
In the Oct. 4 issue of the Journal of the American Medical Association,
scientists from the University of Padua Medical School in Italy looked
at the numbers and found some impressive statistics.
During the 24 years that the program has been used, the annual deaths
among athletes have decreased by 89 percent. Nonathlete-related
spontaneous cardiac death has remained stable during this same time
period.
Initially young athletes were five times more likely to suffer from
SCD than nonathletes. Now they are half as likely, suggesting that the
program may benefit all young people. Experts believe that the United
States is close to such screening techniques for athletes.
"Virtually all high schools and universities use guidelines promulgated
by the American Academy of Sports Medicine," said Peter Schulman, a
cardiologist and associate professor of medicine at the University of
Connecticut School of Medicine.
"They follow most of the guidelines that are used in Italy, except
for the ECG."
One of the concerns of adding ECGs is the cost. In the Italian
study, they say that the average cost of an ECG about $40.
Those that have abnormal findings then have to undergo further
testing to prove or disprove whether the person really has a problem.
The financial costs quickly add up when compared to the very few deaths
the program would prevent in the United States, some experts say.
"There are relatively few sudden deaths in athletes in total," said
Douglas Zipes, director emeritus of the division of cardiology and the
Krannert Institute of Cardiology at the Indiana School of Medicine. "But
when they happen, they are riveting in the public consciousness and are
particularly tragic."
There is also concern about young athletes that will not be able to
participate because of false findings. "How many athletes were
prevented from competitive athletics by the screening?" Zipes said. "Who
didn't need to be excluded and thus had an unnecessary lifestyle
change?"
This is a very important consideration in a country faced with an
obesity epidemic, and physical activity should be encouraged as much as
possible.
This indicates a need for tests that confirm whether the person
really has a problem. The Italian data showed that 3,914 people were
referred for further studies secondary to suspicious findings. Of
these, 879 were eventually restricted from participation, resulting in
the 89 percent reduction in yearly SCDs.
"Even with the standard screening done properly, it's impossible to
prevent all sudden deaths on the athletic field," Schulman said.
With these concerns in mind, experts are still supportive of this type
of system in the United States.
"We should use this evidence to push such a program in the U.S.," said
Alan Kadish, senior associate chief of the cardiology division at
Northwestern University.
Christine Lawless is an associate professor of internal medicine at Ohio
State University in Columbus, Ohio. She is in the process of studying
such a program. "We offer both ECG and echocardiographic screening to
all our athletes as part of a research project whose main objective is
to correlate the ECG findings with underlying cardiac structure and with
ethnic background of the athlete," Lawless said.
Several other universities and school systems throughout the country are
testing similar systems. The success of these programs will be used to
determine whether a nationwide program is possible.