Cost Implications of Athlete ECG Screening Criteria
What are the cost implications of electrocardiographic (ECG) screening in athletes according to the 2010 European Society of Cardiology (ESC) recommendations, and the Seattle and refined interpretation criteria?
Between 2011 and 2014, 4,925 previously unscreened athletes, ages 14-35 years, were prospectively evaluated with history, physical examination, and ECG (interpreted with the 2010 ESC recommendations). Athletes with abnormal results underwent secondary investigations, the costs of which were based on UK National Health Service Tariffs. The impact on cost after applying the Seattle and refined criteria was retrospectively evaluated.
Overall, 1,072 (21.8%) athletes had an abnormal ECG based on 2010 ESC criteria; 11.2% required echocardiography, 1.7% exercise stress test, 1.2% Holter, 1.2% cardiac magnetic resonance imaging, and 0.4% other tests. The Seattle and refined criteria reduced the number of positive ECGs to 6.0% and 4.3%, respectively. After testing, 15 (0.3%) athletes were diagnosed with potentially serious cardiac disease using all three criteria. The overall cost of de novo screening using 2010 ESC recommendations was $539,888 ($110 per athlete and $35,993 per serious diagnosis). The Seattle and refined criteria reduced the cost to $92 and $87 per athlete screened and $30,251 and $28,510 per serious diagnosis, respectively.
Contemporary ECG interpretation criteria decrease costs for de novo screening of athletes, which may be cost permissive for some sporting organizations.
High false-positive rates and cost of additional investigations is an obstacle to routine ECG screening of young athletes for cardiac disease. The use of refined criteria for ECG interpretation that are more specific to the detection of cardiac disease in athletes helps lower the cost of additional testing. Of paramount importance is the use of established ECG criteria specific to athletes.
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