Cost Implications of Using Different ECG Criteria for Screening Young Athletes in the United Kingdom

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY

卷:68

Article

Dhutia, Harshil¹  Malhotra, Aneil¹  Gabus, Vincent¹  Merghani, Ahmed¹  Finocchiaro, Gherardo¹  Millar, Lynne¹  Narain, Rajay¹  Papadakis, Michael¹  Naci, Huseyin²  Tome, Maite¹  Sharma, Sanjay^1,2 

[1] St Georges Univ London, Div Cardiovasc Sci, Cranmer Terrace, London SW17 0RE, England

[2] London Sch Econ & Polit Sci, Dept Social Policy, LSE Hlth, London, England

关键词: athlete;    electrocardiogram;    pre-participation screening;    sudden cardiac death;   

DOI  :  10.1016/j.jacc.2016.05.076

来源: Elsevier

【 摘 要 】

BACKGROUND High false-positive rates and cost of additional investigations are an obstacle to electrocardiographic (ECG) screening of young athletes for cardiac disease. However, ECG screening costs have never been systematically assessed in a large cohort of athletes. OBJECTIVE This study investigated the costs of ECG screening in athletes according to the 2010 European Society of Cardiology (ESC) recommendations and the Seattle and refined interpretation criteria. METHODS Between 2011 and 2014, 4,925 previously unscreened athletes aged 14 to 35 years were prospectively evaluated with history, physical examination, and ECG (interpreted with the 2010 ESC recommendations). Athletes with abnormal results underwent secondary investigations, the costs of which were based on U.K. National Health Service Tariffs. The impact on cost after applying the Seattle and refined criteria was evaluated retrospectively. RESULTS Overall, 1,072 (21.8%) athletes had an abnormal ECG on the basis of 2010 ESC recommendations; 11.2% required echocardiography, 1.7% exercise stress test, 1.2% Holter, 1.2% cardiac magnetic resonance imaging, and 0.4% other tests. The Seattle and refined criteria reduced the number of positive ECGs to 6.0% and 4.3%, respectively. Fifteen (0.3%) athletes were diagnosed with potentially serious cardiac disease using all 3 criteria. The overall cost of de novo screening using 2010 ESC recommendations was $539,888 ($110 per athlete and $35,993 per serious diagnosis). The Seattle and refined criteria reduced the cost to $92 and $87 per athlete screened and $30,251 and $28,510 per serious diagnosis, respectively. CONCLUSIONS Contemporary ECG interpretation criteria decrease costs for de novo screening of athletes, which may be cost permissive for some sporting organizations. (C) 2016 by the American College of Cardiology Foundation.

【 授权许可】

Free