Assessment of the 12-Lead Electrocardiogram as a Screening Test for Detection of Cardiovascular Disease in Healthy General Populations of Young People (12–25 Years of Age): A Scientific Statement From the American Heart Association and the American College of Cardiology

Perspective:

The following are 10 points to remember about this scientific statement:

1. The present report includes considerations for screening large, young, and truly general populations (school-aged, 12-25 years old, of both sexes) with respect to relevant logistical, ethical, legal, and societal issues (e.g., in the United States or other countries or communities of various sizes, in schools, or in regional or military populations).

2. The writing committee affirms that cardiovascular screening programs (independent of size, scope, or design) should be driven by sound scientific principles and policy rather than by relatively rare catastrophic events, or emotion.

3. It is recommended that the American Heart Association (AHA) 14-point screening guidelines and those of other societies, such as the Pre-participation Physical Evaluation monograph, be used by examiners as part of a comprehensive history-taking and physical examination to detect or raise suspicion of genetic/congenital and other cardiovascular abnormalities (Class I; Level of Evidence C).

4. The 14-element AHA recommendations for pre-participation cardiovascular screening of competitive athletes include 14 items (10 for personal and family history and 4 for physical examination).

5. It is recommended that standardization of the questionnaire forms used as guides for examiners of high school and college athletes in the United States be pursued (Class I; Level of Evidence C).

6. Screening with 12-lead electrocardiograms (ECGs) (or echocardiograms) in association with comprehensive history-taking and physical examination to identify or raise suspicion of genetic/congenital and other cardiovascular abnormalities may be considered in relatively small cohorts of young healthy people 12-25 years of age, not necessarily limited to athletes (e.g., in high schools, colleges/universities, or local communities), provided that close physician involvement and sufficient quality control can be achieved. If undertaken, such initiatives should recognize the known and anticipated limitations of the 12-lead ECG as a population screening test, including the expected frequency of false-positive and false-negative test results, as well as the cost required to support these initiatives over time (Class IIb; Level of Evidence C).

7. Mandatory and universal mass screening with 12-lead ECGs in large general populations of young healthy people 12-25 years of age (including on a national basis in the United States) to identify genetic/congenital and other cardiovascular abnormalities is not recommended for athletes and nonathletes alike (Class III; Level of Evidence C).

8. Consideration for large-scale, general population, and universal cardiovascular screening in the age group 12-25 years with history-taking and physical examination alone is not recommended (including on a national basis in the United States) (Class III; Level of Evidence C).

9. The preponderance of evidence indicates that sudden death in young athletes (and probably nonathletes) in the age range of 12-25 years should be regarded as a low event rate occurrence.

10. Currently, there is insufficient information available to support the view that universal screening ECGs in asymptomatic young people for cardiovascular disease is appropriate or possible on a national basis for the United States, either in competitive athletes or in the general youthful population. The ECG can promote detection of specific cardiovascular diseases and thereby benefit some individuals in a screening environment, but cannot be regarded as an ideal or effective test when applied to large healthy populations.

Clinical Topics: Arrhythmias and Clinical EP, Sports and Exercise Cardiology, SCD/Ventricular Arrhythmias

Keywords: Athletes, Quality Control, Cardiovascular Abnormalities, Electrocardiography, Questionnaires, Universities, Physical Examination, Death, Sudden, Cardiac


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