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Al-Khatib SM, Yancy CW, Solis P, Becker L, Benjamin EJ, Carrillo RG, Ezekowitz JA, Fonarow GC, Kantharia BK, Kleinman M, Nichol G, Varosy PD. 2016 AHA/ACC Clinical Performance and Quality Measures for Prevention of Sudden Cardiac Death: A Report of the American College of Cardiology/American Heart Association Task Force on Performance Measures. Circ Cardiovasc Qual Outcomes 2017; 10:e000022. [DOI: 10.1161/hcq.0000000000000022] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Asif IM, Drezner JA, O'Connor FG. Cardiovascular Preparticipation Screening in Young Athletes: Looking Through One Lens. Sports Health 2017; 9:19-21. [PMID: 30043692 PMCID: PMC5315265 DOI: 10.1177/1941738116680188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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No Evidence for Femoral Pulse Evaluation in Normotensive College Athletes During Sports Preparticipation Examinations. J Am Coll Cardiol 2016; 68:2242. [PMID: 27855819 DOI: 10.1016/j.jacc.2016.07.784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Accepted: 07/12/2016] [Indexed: 11/24/2022]
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Hainline B, Drezner JA, Baggish A, Harmon KG, Emery MS, Myerburg RJ, Sanchez E, Molossi S, Parsons JT, Thompson PD. Reply: No Evidence for Femoral Pulse Evaluation in Normotensive College Athletes During Sports Preparticipation Examinations. J Am Coll Cardiol 2016; 68:2242-2243. [PMID: 27855820 DOI: 10.1016/j.jacc.2016.07.782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 07/26/2016] [Indexed: 10/20/2022]
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Drezner JA, O'Connor FG, Harmon KG, Fields KB, Asplund CA, Asif IM, Price DE, Dimeff RJ, Bernhardt DT, Roberts WO. AMSSM Position Statement on Cardiovascular Preparticipation Screening in Athletes: Current evidence, knowledge gaps, recommendations and future directions. Br J Sports Med 2016; 51:153-167. [PMID: 27660369 DOI: 10.1136/bjsports-2016-096781] [Citation(s) in RCA: 90] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2016] [Indexed: 11/04/2022]
Abstract
Cardiovascular screening in young athletes is widely recommended and routinely performed prior to participation in competitive sports. While there is general agreement that early detection of cardiac conditions at risk for sudden cardiac arrest and death (SCA/D) is an important objective, the optimal strategy for cardiovascular screening in athletes remains an issue of considerable debate. At the centre of the controversy is the addition of a resting ECG to the standard preparticipation evaluation using history and physical examination. The American Medical Society for Sports Medicine (AMSSM) formed a task force to address the current evidence and knowledge gaps regarding preparticipation cardiovascular screening in athletes from the perspective of a primary care sports medicine physician. The absence of definitive outcome-based evidence at this time precludes AMSSM from endorsing any single or universal cardiovascular screening strategy for all athletes, including legislative mandates. This statement presents a new paradigm to assist the individual physician in assessing the most appropriate cardiovascular screening strategy unique to their athlete population, community needs and resources. The decision to implement a cardiovascular screening programme, with or without the addition of ECG, necessitates careful consideration of the risk of SCA/D in the targeted population and the availability of cardiology resources and infrastructure. Importantly, it is the individual physician's assessment in the context of an emerging evidence base that the chosen model for early detection of cardiac disorders in the specific population provides greater benefit than harm. AMSSM is committed to advancing evidenced-based research and educational initiatives that will validate and promote the most efficacious strategies to foster safe sport participation and reduce SCA/D in athletes.
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Affiliation(s)
- Jonathan A Drezner
- Department of Family Medicine, University of Washington, Seattle, Washington, USA
| | - Francis G O'Connor
- Department of Military and Emergency Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Kimberly G Harmon
- Department of Family Medicine, University of Washington, Seattle, Washington, USA
| | - Karl B Fields
- Department of Family Medicine, University of North Carolina, Greensboro, North Carolina, USA
| | - Chad A Asplund
- Department of Health and Kinesiology, Georgia Southern University, Statesboro, Georgia, USA
| | - Irfan M Asif
- Department of Family Medicine, University of South Carolina Greenville School of Medicine, Greenville, South Carolina, USA
| | - David E Price
- Department of Family Medicine, Carolinas Healthcare System, Charlotte, North Carolina, USA
| | - Robert J Dimeff
- Departments of Orthopedic Surgery, Family and Community Medicine, and Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - David T Bernhardt
- Departments of Pediatrics, Orthopedics and Rehabilitation, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - William O Roberts
- Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, Minnesota, USA
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Drezner JA, Owens DS, Prutkin JM, Salerno JC, Harmon KG, Prosise S, Clark A, Asif IM. Electrocardiographic Screening in National Collegiate Athletic Association Athletes. Am J Cardiol 2016; 118:754-9. [PMID: 27496294 DOI: 10.1016/j.amjcard.2016.06.004] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 06/03/2016] [Accepted: 06/03/2016] [Indexed: 10/21/2022]
Abstract
The most effective protocol for cardiovascular screening of competitive athletes remains highly controversial. This study was a prospective, multicenter trial of cardiovascular screening at 35 National Collegiate Athletic Association institutions. Screening included a standardized history and physical examination (PE) as recommended by the American Heart Association and a 12-lead electrocardiogram (ECG) at rest. Centralized electrocardiographic interpretation was provided using the Seattle criteria. Athletes with screening abnormalities underwent additional evaluation directed by the host institution medical team. Primary outcomes included the proportion of total and false-positive screens; the sensitivity, specificity, and positive predictive value of history, PE, and ECG; and the prevalence of serious cardiovascular disorders associated with severe morbidity or sudden cardiac death. From August 2012 to June 2014, 5,258 athletes from 17 intercollegiate sports were screened: 55% men (mean age 20.1 years), 73% Caucasian, 16% African-American, and 11% other/mixed race. At least 1 positive cardiac symptom or family history response was reported by 1,750 athletes (33.3%). PE was abnormal in 108 athletes (2.1%), and electrocardiographic abnormalities were present in 192 athletes (3.7%). Thirteen athletes (0.25%) were identified with serious cardiac conditions including hypertrophic cardiomyopathy (1), large atrial septal defect with right ventricular dilation (1), and ventricular pre-excitation (11). The false-positive rate for history was 33.3%, PE 2.0%, and ECG 3.4%. The sensitivity/specificity/positive predictive value for history was 15.4%/66.9%/0.1%, PE 7.7%/98.2%/0.9%, and ECG 100%/96.6%/6.8%. In conclusion, electrocardiographic screening in National Collegiate Athletic Association athletes has a low false-positive rate and provides superior accuracy compared with a standardized history and PE to detect athletes with potentially dangerous cardiovascular conditions.
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Lavie CJ, Harmon KG. Routine ECG Screening of Young Athletes. J Am Coll Cardiol 2016; 68:712-4. [DOI: 10.1016/j.jacc.2016.06.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2016] [Accepted: 06/27/2016] [Indexed: 01/13/2023]
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Joy EA, Pescatello LS. Pre-exercise screening: role of the primary care physician. Isr J Health Policy Res 2016; 5:29. [PMID: 27358724 PMCID: PMC4926293 DOI: 10.1186/s13584-016-0089-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 06/13/2016] [Indexed: 11/10/2022] Open
Abstract
Participation in regular physical activity is associated with a multitude of benefits including a reduction in chronic disease and premature mortality, and improved quality of life. All segments of society need to collaborate with one another in an effort to promote active lives. The Israeli "Gymnasium Law" requires pre-exercise evaluation prior to exercise participation in a health club. Recently that law was modified to allow for participant pre-screening with the Physical Activity Readiness Questionnaire for Everyone (PAR-Q+). This change reflects the evidence that the risk of catastrophic events (e.g. heart attack) during moderate intensity physical activity is low, and the likelihood of detecting heart disease in asymptomatic adults is low. This change will likely reduce the number of individuals who require physician evaluation. The American College of Sports Medicine (ACSM) recently updated their recommendations for pre-exercise evaluation. The ACSM guidelines have replaced risk factor assessment, with an algorithm that first stratifies based on current physical activity level, then by the presence of chronic disease, and/or signs and symptoms of chronic disease, and last by desired exercise intensity. The goal of these efforts is to reduce barriers to regular physical activity, by eliminating unnecessary medical evaluations. All adults should be encouraged to be physically active.
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Affiliation(s)
- Elizabeth A. Joy
- />Community Benefit Department, Intermountain Healthcare, 36 S. State St, 23rd floor, Salt Lake City, UT 84111 USA
| | - Linda S. Pescatello
- />Department of Kinesiology & Human Performance Laboratory, College of Agriculture, Health and Natural Resources, University of Connecticut, Storrs, Conneticut USA
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