Outcomes of a cardiac screening program: are those referred worse off?

Abstract

Abstract Funding Acknowledgements Type of funding sources: Other. Main funding source(s): 1. Cardiovascular PHD Scholarship awarded by Research, Innovation and Development Trust Malta (supported by Beating Hearts Malta). 2. Tertiary Education Scholarship Scheme. Introduction Awareness of sudden cardiac death in young individuals is gaining momentum. The evidence supporting screening in non-athletic individuals is also growing, but outcome data in this subgroup is lacking. Objective This study assessed the short-term outcomes of a large cohort of screened Maltese adolescent individuals. Outcome analysis was also extended to a large group of age matched individuals who were not offered systematic screening. Methodology Fifth form students (born 2002) were systematically invited to undergo cardiac screening in the 2017/2018 scholastic year. Most were cleared at screening (Group 1). The rest were referred at enrolment or had an abnormal ECG with a known diagnosis (Group 2). Events since enrolment were obtained from hospital databases. Outcome analysis for adolescents born in 2001 who were alive and residing in Malta in 2017 was also conducted (Group 3). Data was collected through public registries. These individuals were not offered systematic cardiac screening. An event was defined as death, hospitalisation (cardiac symptoms with abnormal findings, arrhythmias or heart failure) or cardiac intervention. Kaplan Meier and log rank analysis (IBM SPSS Statistics vs23) were used to determine the event free proportion in both groups. Events deemed to be of an acquired nature (inflammatory disorders or trauma) were disregarded. Results The cohort consisted of 6580 adolescents. Groups 1 and 2 included 2672 adolescents (mean age 15.0±0.33 years, 50.4% female). 109 (4.1%) were referred for further evaluation. After a median follow-up of 52±2 months, 9 (0.3%) subjects experienced an event. No deaths were recorded. Events included hospitalisation (Group 1: n=2, Group 2: n=5) and interventions (Group 1: Pacemaker n=1, Group 2: EPS & ILR n=6). One subject (Group 2) had 3 events. Group 2 were more likely to experience an event (p<0.001). 99.9% in Group 1 and 94.8% in Group 2 remained event free. Group 3 consisted of 3913 subjects. This group was also followed up for 52±1 months. Three subjects (0.1%) had an event (n=1 hospitalisation with a new diagnosis of cardiomyopathy, n=2 EPS & ILR) at a similar rate as group 1 (p=0.097) and lower compared to group 2 (p<0.001). 99.9% remained event free. Conclusion Participants in group 2 were more likely to experience an event. Cardiac screening does not offer any outcome benefit in the short term. Studies with longer follow-up periods are required to determine the efficacy of a cardiac screening program.