Legislative mandates for universal electrocardiogram (ECG) screening in competitive athletes pose potential harm and unintended consequences, drawing attention and resources away from emergency action plan (EAP) implementation, an effective intervention for saving athletes' lives, according to a Societal Statement published Feb. 13 in JACC.

At a time of growing interest at the state level in protecting the lives of young competitive athletes from sudden cardiac arrest (SCA), Jonathan H. Kim, MD, MSc, FACC, et al., present several drawbacks of adding universal ECG screening to the pre-participation physician evaluation (PPE), which already involves a 14-point history and physical examination to help identify unrecognized disease, established disease or a family history of inheritable cardiovascular disorders.

The report suggests that current health systems in the U.S. could not handle the increased demand for ECG screening and interpretation, leading to "a higher number of inappropriately interpreted ECGs and unnecessary follow-up testing, financial burden on families, psychological stress on the athletes, and potentially missed diagnoses." It also warns of delays in care for both competitive athletes seeking screening, impacting return-to-play, and other cardiac patients who require diagnostic testing, which could negatively impact clinical outcomes.

Kim and colleagues weigh the costs of universal ECG screening with current evidence and limitations. For a medium-sized state like Georgia, they estimate a yearly cost of $10 million for one-time ECG screenings. While they acknowledge "the addition of ECG screening can be reasonable because it enhances the detection of conditions associated with SCA," they state that "mortality benefits have yet to be confirmed and unintended harms are likely if ECG screening is not carefully considered, planned, and then implemented."

Equitable access is also considered in the statement, noting how low socioeconomic status, lack of insurance and the distance needed to travel to reach appropriate sports cardiology care could place additional burdens on families.

According to the Writing Committee, "an effective EAP, including access to early defibrillation and cardiopulmonary resuscitation education and training, is the only intervention that is established as lifesaving for all young individuals at risk for SCA." They encourage legislators to prioritize EAP mandates to help protect the lives of young competitive athletes.

EAPs are one of three evidence-based policies that the ACC is advocating for in several states along with the Smart Heart Sports Coalition. Learn more about the College's work to champion access to care for all.