Public Health Feature - August 2005
By Erin Prather
Austin cardiologist George Rodgers, MD, has a personal reason for wanting to save young athletes' lives. He knows firsthand the shock of a seemingly healthy young athlete suddenly dropping dead.
"This issue is what essentially got me interested in cardiology," said Dr. Rodgers, a cardiologist at the Austin Heart Hospital. "I went to a small high school in Houston. A close friend of mine died suddenly at a track meet from sudden cardiac death. He was one of the school's best athletes, and he died from a physical condition unknown to him or his family."
Losing a young person to illness is traumatic. Suffering that loss without warning is devastating. When high school athletes take the field, the possibility that they could die is seldom considered. Yet it happens, and the cause is often a silent killer -- sudden cardiac death. Houston's Texas Children's Hospital reports that nationwide sudden cardiac death kills from 1 in 100,000 to 1 in 300,000 high school age athletes per year.
The condition has numerous causes, including hypertrophic cardiomyopathy, myocarditis, coronary artery abnormalities, or Marfan syndrome. Four years ago, sudden cardiac death killed four Texas teenagers in one month. The deaths prompted the U niversity Interscholastic League (UIL) to establish a medical advisory committee to examine the health and safety of students involved in sports.
Committee member Arnold L. Fenrich, MD, assistant professor in the Department of Pediatrics (Cardiology) at Texas Children's Hospital, says its first job was to improve the preparticipation form used to document the results of an athlete's history and physical to make it more comprehensive and cover areas that screen for a possible risk of sudden cardiac death.
"It is well understood that this type of screening is not 100 percent, but the form can at least identify athletes with a history that warrants further investigation. Further evaluation can also be recommended if the physical does detect something. The committee was successful in making it mandatory for public schools to use this form."
Dr. Rodgers is president of the Austin Heart Foundation, which is committed to reducing cardiovascular disease in central Texas by promoting education, awareness, and lifesaving technology. One of its programs, Championship Hearts, screens high school athletes for hypertrophic cardiomyopathy. Another, Keeping the Beat, works with Championship Hearts to teach students how to use automated external defibrillators (AEDs).
"Hypertrophic cardiomyopathy is an odd heart condition because it does not impair sports ability. It's difficult to pick up with a stethoscope, but easy to pick up with an echocardiogram," Dr. Rodgers said. "The Austin Heart Foundation makes it possible to provide this service to students free of cost. Physicians volunteer their time, the foundation pays the technicians, and the hospital has the mobile equipment."
Is Screening Appropriate?
How to further screen students to prevent sudden cardiac death has been heavily debated by cardiologists. A common concern is that the small number of athletes afflicted by the condition doesn't justify the cost of implementing a massive screening program.
An article in the June 2004 issue of The Physician and Sportsmedicine said the "most important characteristic of an effective screening program is that the suspected condition has a significant impact on public health. Sudden cardiac death in young athletes fails to meet this criterion."
But Donald Williams, MD, medical director of the Austin Independent School District Student Health Services, worries that mass cardiovascular screenings can result in false-positive test results. That could create unnecessary stress for athletes and their families, exclude youngsters from competition, and even prevent them from obtaining life insurance coverage.
"If there were more consensus in the medical community that cardiac screenings were useful for communities at large, then I think I'd be more positive about screenings being more widespread," he said. "Although the American Heart Association does not discourage the efforts of individual investigators who have implemented screening programs, it does maintain that a complete and careful personal and family history and physical examination is the most practical approach to screening populations of competitive sports participants, regardless of age."
Dr. Williams also says screening for one particular heart condition may overlook another and cause a false sense of security.
"Every parent should understand that cardiac screenings are not a cure-all. Implementing a mass screening program is not a cut-and-dried issue. There are a lot of ethics that come into play. This is a complex issue, one that I think a lot of physicians struggle with to determine whether more advanced screenings should be done."
One point cardiologists do agree on is the importance of defibrillators. The heart association encourages businesses and public facilities to install the devices to increase the chances that a person with a heart-related emergency will survive. The problem is that few people know how to use them.
"I have asked the UIL to make it mandatory for school faculty and students to have CPR and AED training," said Dr. Fenrich. "I'm a firm believer that AEDs should follow the path of fire extinguishers and become common in households and public places. I know of three individuals who have been saved by an AED in the last six months. If generations of kids grow up knowing CPR and how to use an AED, communities as a whole will be better off."
In 2003, President Bush signed the Automatic Defibrillation in Adam's Memory Act. It authorizes use of certain grant funds to "establish an information clearinghouse that provides information to increase public access to defibrillation in schools." However, funding for Adam's Act has been cut since the bill's passage, and Dr. Fenrich has petitioned Congress to reconsider its budgeting for the program.
"Physicians who are interested in this issue should check to see if their local school has already implemented CPR and AED training within its curriculum. If it hasn't, pushing for a program is a good place to start."
Erin Prather can be reached at (800) 880-1300, ext. 1385, or (512) 370-1385; by fax at (512) 370-1629; or by email at Erin Prather.
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