Performance of the AHA 14-Point Evaulation vs Electrocardiography


Performance of the American Heart Association (AHA) 14-Point Evaluation Versus Electrocardiography for the Cardiovascular Screening of High School Athletes: A Prospective Study

Full Description

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.)

Additional information


Elizabeth A. Williams, Hank F. Pelto, Brett G. Toresdahl, Jordan M. Prutkin, David S. Owens, Jack C. Salerno, Kimberly G. Harmon, Jonathan A. Drezne


Journal of American Heart Association


9 pages

Publication Date