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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 mosteffective 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 underwentcardiovascular screening using the AHA 14-point history and physical examination, and an ECG interpreted with the SeattleCriteria. A limited echocardiogram was performed for all screening abnormalities. The primary outcome measure was identificationof 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 tothe 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 presentin 356 (9.8%) athletes, and 103 (2.8%) athletes had an abnormal ECG. Sixteen (0.4%) athletes had conditions associated withsudden cardiac death. The sensitivity (18.8%), specificity (68.0%), and positive predictive value (0.3%) of the AHA 14-pointevaluation 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 schoolathletes. The use of consensus-derived history questionnaires as the primary tool for cardiovascular screening in athletes shouldbe 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 |
|---|---|
| Source | Journal of American Heart Association |
| Length | 9 pages |
| Publication Date | 8/1/19 |
