Screening athletes for heart problems much too pricey

When it comes to professional footballers, problems of the heart are often to do with their latest tryst. But lately, they have taken a much more serious nature.

This week, 27-year-old Mitchell Cole died of heart disease, a year after he was forced to retire from professional soccer in the UK following a heart attack. This follows a report last week that another British footballer, Radwan Hamed, who was only 17 when he had a heart attack on the pitch, will be suing his former club, Tottenham Hotspur, over the brain damage that he suffered as a result.

Why not screen all professional athletes for heart problems, as some cardiologists and sports scientists argue? A new study suggests that the costs of such a programme would be too high.

Yet screening has been standard practice in Italy since 1982. Every professional athlete there regularly has an electrocardiogram (ECG) to measure the electrical activity of their heart. Any unusual activity can signal a problem that may be exacerbated by intense exercise. If so, a cardiologist may recommend that an athlete end their career.

Domenico Corrado and his colleagues at the University of Padua in Italy say that the screening has reduced the annual incidence of sudden cardiac disease (SCD) among Italian athletes by 89 per cent. The country now has one of the lowest rates of SCD in the world.

How much would a similar programme cost in the US? To find out, Sami Viskin, a cardiologist at Tel Aviv University, Israel, looked at the Italian screening data to establish how often athletes needed to be screened. He also estimated how many US athletes would need screening ? including high school and college athletes in view of the importance that sport has for many US students, for example, in providing access to scholarships.

Viskin concluded that mandatory screening of US athletes would cost a staggering $10 million per life saved. Over 20 years, such a programme could save nearly 5000 lives.

Balancing the cost

Gordon Tomaselli, a cardiologist at Johns Hopkins University in Baltimore, Maryland, and spokesperson of the American Heart Association, says that cost is unreasonable. The World Health Organization's guidelines state that the total cost of diagnosing a condition should be economically balanced in relation to medical expenditure as a whole. "$10 million is very high," says Tomaselli.

The huge price tag is not the only problem with ECG screening, says Viskin ? in addition, the test results are open to a degree of interpretation. "Physicians know what to look for, but they don't know what to do when they see abnormalities," he says. "The risk of SCD is higher, but in absolute terms it's still very low."

Limited financial resources could be put to better use for athletes at risk of SCD, Viskin adds. "Putting defibrillators everywhere and training people in cardiopulmonary resuscitation would probably save more lives."

Journal reference: JAMA, doi.org/dfzdmp

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