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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
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. ( J Am Heart Assoc. 2019;8:e012235. DOI: 10.1161/JAHA.119.012235.)
Contributor | Elizabeth A. Williams, Hank F. Pelto, Brett G. Toresdahl, Jordan M. Prutkin, David S. Owens, Jack C. Salerno, Kimberly G. Harmon, Jonathan A. Drezne |
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Source | Journal of American Heart Association |
Length | 9 pages |
Publication Date | 8/1/19 |
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