Abstract 14866: Athletic Heart Screening: Usefulness of Echocardiography and Economic Impact

Abstract

Background: The athletic heart screen (AS) for sudden cardiac death (SD) detection is controversial in the USA. EKG use is common in AS programs but ECHO is uncommon. Our study aims to determine the effectiveness of ECHO in identifying athletes at risk for SD that would have been missed without ECHO and to evaluate the cost of AS. Methods: AS and medical records were reviewed. AS consisted of a self-completed questionnaire, EKG and limited ECHO. AS were abnormal at the discretion of the reader at the time they were reviewed. Data is expressed as percentage. Cost is calculated using average reimbursement for the ensuing initial cardiac evaluation. Results: In 10 years, 2016 AS were randomly assigned to 5 pediatric cardiologists. There were 336 (16.7%) abnormal AS. The rate of abnormal AS was 79/244 (12.1%), 19/190 (10%), 82/630 (31.2%), 7/63 (11%), and 164/889 (18.4%) for the reviewers, representing a wide variability in the percentage of abnormal AS among reviewers. This resulted in 166 (49.4%) initial cardiac evaluations leading to 207 noninvasive testing in addition to repeat EKG in some cases. Testing included ECHO, Holter, stress test and cardiac CT and MRI. Initial evaluation was normal in 103 (62.0%) cases. Invasive interventions included: 3 small ASD closures, 1 moderate PDA closure, an EP ablation for WPW, and 1 surgery for abnormal right coronary artery origin (ARCA). In the remaining 57 (34.3%) cases, the cardiac abnormalities identified were mild including: prominent aortic root, premature complexes, and mild left-sided valve abnormalities in asymptomatic individuals. Conservatively, 2 diagnoses would be low risk for SD: WPW and ARCA representing <0.1% of all AS performed. An abnormal AS was made by ECHO in 184/336 (54.8%) cases leading to 105 evaluations: 55 (52.4%) were normal, 45 (42.8%) had mild abnormalities, and 5 (4.8%) had the ASD and PDA closures, and the coronary surgery. The cost of 2016 AS was $100,000. The cost of the 166 first evaluations performed including noninvasive testing was $160,462. Conclusions: AS results are reviewer-dependent and low yield for detecting conditions at high risk for SD. The addition of ECHO can identify mild congenital heart disease and coronary abnormalities at the expense of increasing costs, acutely and long term.