Physicals and heart screening
Off topic today with a look at high school sports physicals in the state of Michigan and one young man who pursued his passion despite a serious heart condition.
And then there's the heart screening debate, which is getting more interesting with the release of some recent studies. The full version of that story is pasted below:
Quotable
“There’s some emotion that comes around this issue when you’re talking about people dying young. I appreciate that. … Sometimes we rely on medical equipment to tell us what’s going on, but let’s not underestimate the conversation between these doctors and these athletes, and their parents.”
-- American Heart Association Midwest Affiliate senior director of advocacy Katherine Knoll, on the AHA’s recommendation to bolster heart screening with more thorough medical history information rather than ECG tests
“It all comes down to one thing: the almighty dollar. I would do anything it takes. One life saved is worth all of it. If only insurance companies would realize that it’s cheaper in the long run to take care of these issues.”
-- East Lansing resident Kandi Lefkowitz, whose son Jameson Hartley is living with a rare and dangerous heart condition
Joe Rexrode
jrexrode@lsj.com
For every logical rebuttal given, every billion dollars of extra cost projected, there is an individual tragedy jarring enough to keep the question alive.
Why don’t we screen our children for heart problems that can cause sudden cardiac arrest?
They are rare – car accidents, homicide, suicide and cancer kill more teens each year. But in most cases of sudden cardiac arrest, the first symptom is death.
And those deaths, of seemingly healthy young people in seemingly harmless situations, feed an emotion-charged issue. ECG (electrocardiogram) tests may miss some things or falsely red-flag others, but proponents believe it’s worth the extra cost to add them to sports physicals.
“One life saved is more than worth it as far as I’m concerned,” said East Lansing resident Kandi Lefkowitz, whose teenage son was saved from possible sudden cardiac death by a 2002 eye exam when he was 12, “especially if you’re the parents of a child that’s happened to.”
It was one year ago that 14-year-old Dorian Dawkins, a superb athlete from Saginaw, collapsed on a basketball court in East Lansing and died hours later of a rare and previously undetected heart condition.
It was nine years ago that 22-year-old John Munley collapsed while jogging in East Lansing. He died almost instantly of an enlarged heart, an ailment that was never diagnosed through four years as a Michigan State University swimmer.
In between those tragedies, young professional athletes including Korey Stringer, Darryl Kile, Thomas Herrion and Jason Collier perished suddenly in high-profile failures of the heart.
Those cases and others like them have armed the push to make ECG screening a routine part of sports physicals for young athletes.
Italy made annual ECG screening a government-subsidized requirement 25 years ago for athletes between the ages of 12 and 35 – and reports an 89 percent annual decline in the incidence of sudden cardiac death in its young athletes, according to an American Heart Association study.
COST VS. RISK
Even the staunchest of ECG advocates realize that the United States health-care system is not in a position to add cost at this point. Insurance companies will not pay for ECG tests unless a patient has a reason to get one.
The American Heart Association, which does not support routine ECG youth screening, projected in the same 2007 study an annual cost of $2 billion for the estimated 10 million high school and middle school athletes in the United States to be screened.
That $2 billion estimate includes projections of extra testing – such as an electrocardiogram, or heart ultrasound -- that would be needed for those who show irregularities in the ECG screening.
The AHA believes a more thorough exploration of a patient’s medical history in physicals is the most feasible way to bolster heart screenings, said Katherine Knoll, senior director of advocacy for the AHA’s Okemos-based Midwest branch.
The Michigan Department of Community Health concurs, said genomics coordinator Debra Duquette, in part because many heart ailments that strike the young are genetic – meaning a patient’s family medical history should indicate a potential problem. Others disagree.
“We don’t want to overtax an already overtaxed health system, but in time, say 10 years, we think it will (become routine), just like it did with mammograms,” said Jayne Vining, whose Andover, Mass.-based CAS (Cardiac Arrhythmia Syndromes) Foundation is in the midst of a three-year project to give free and voluntary ECG screenings to students – athletes and non-athletes -- at 27 high schools in Hillsborough County, Fla.
“In this situation, you have to raise awareness and let parents make the decision,” said Dr. Aajay Shah, an Okemos cardiologist. “We need to make people aware and let them know that it’s worth spending the money. If there are two kids in Lansing whose hearts can kill them, they need to be picked up.”
And that’s another issue. ECG tests don’t detect every kind of dangerous heart ailment. False positives are possible – a recent Harvard study resulted in false positives for 16 percent of the 510 college athletes scanned -- and can lead to unnecessary and expensive further testing.
CONFLICTING DATA
And of those 10 million athletes, an AHA study estimated about 90 die a year in the United States of sudden cardiac death. That’s 1 in 111,000, which is hardly an epidemic.
“You don’t want one child to die unexpectedly because of an undiagnosed medical issue,” said Steve Serkaian, spokesman for the Lansing School District. “But medical professionals will say it’s not necessary. Do you create yet another un-funded mandate on families, when state officials have determined that a basic sports physical is enough?”
“Where do you draw the line on matters like this? Are you going to require a full body scan, just because the technology exists?”
Those numbers are in dispute, though. Vining’s foundation claims that 7,000 people between the ages of 6 and 18 die in the United States each year of sudden cardiac arrest.
There is no national registry, Vining said, so many such deaths are not accurately reported at first.
A 1999 Centers for Disease Control study reported 1,291 sudden cardiac deaths in the United States that year among people aged 15 to 24.
A more recent CDC study reported that from 1999 to 2006, an average of 16,375 teens (between ages 12 and 19) died each year.
A total of 491, or 3 percent, of those each year were from “heart disease,” although the study did not say how many were of the “sudden” and undiagnosed variety.
Accidental deaths made up 48 percent of the total (7,860), and 73 percent of those, or 5,738, were from car accidents. Homicide accounted for 13 percent of the deaths, suicide 11 percent and cancer 6 percent.
So if the CDC numbers are accurate, it’s nearly 12 times more likely for a teen to die in a car accident than of a heart-related problem.
NEW INFORMATION
Even at MSU, which counts about 800 scholarship athletes, ECG testing is not done on a routine basis. Some college athletic departments, such as Washington and Stanford, have added it recently, but it’s not imminent at MSU.
“The cost and large number of false positive findings (are) prohibitive,” said Dr. Jeff Kovan, director of MSU sports medicine. “The false negatives will also lead to a false sense of security for many since a spot (ECG) cannot find all arrhythmias and possible concerns.”
Some medical professionals will say it’s necessary, though. The aforementioned Harvard study, released in March, found that adding an ECG to a routine physical doubled the number of subjects with heart problems who were identified.
Harvard has decided to continue screening all of its athletes.
“We need to have the NCAA and other athletic bodies join in the fray and say enough is enough,” Indiana University professor Dr. Douglas Zipes told the Boston Globe in the wake of the study’s release. “Let’s implement mandatory (ECGs) to save lives and identify the youngsters at risk before they have an event.”
One such youngster is Connor Moore, a 15-year-old track athlete in the Hillsborough County school system in Florida. He came up irregular in April on the free ECG test given by Vining’s CAS Foundation.
Moore was transported to All-Children’s Hospital in St. Petersburg, where doctors have agreed to donate their expertise to the CAS project. He was diagnosed with a curable – yet potentially fatal if untended -- heart arrhythmia called Wolff-Parkinson-White Syndrome.
Moore is scheduled for a repair this summer. He is the only one of hundreds of students tested so far in the Hillsborough County project to be diagnosed with a serious condition.
The stories, of those lost and saved, aren’t abundant. But they are powerful.
“He sent me his picture and said he wanted me to see the face of someone I saved,” Vining said of Moore. “Every time I look at it, I cry.”
