This post was authored by former ACC President Alfred Bove, MD, PhD, MACC.

In the news this week, Alexander Dale Oen, a world champion swimmer from Norway died during training camp in Flagstaff, AZ, after suffering a cardiac arrest. He was 26. Oen won the 100 breaststroke at the worlds in Shanghai last July and took silver at the 2008 Beijing Olympics. He was expected to compete in the Olympics in London this summer.

Oen is not the first, nor unfortunately last, young athlete to suffer from sudden cardiac death. A recent policy statement published in March by the American Academy of Pediatrics estimates that 2,000 people under the age of 25 die from sudden cardiac arrest in the U.S. every year.

As we head into Spring training seasons for high schools, colleges and major-league teams, as well as look ahead to the summer Olympics, this latest death will likely add continued fuel to the debate about whether to require EKGs in addition to physical exams for younger athletes participating in high-intensity sports. Both the American College of Cardiology and the American Heart Association agree that the mandatory screening of all young athletes with an ECG is not warranted based on cost (due to the large number of tests that would be required), the low incidence of sudden death among athletes in the United States, as well as the concern for false positive results. However overseas, both the European College of Cardiology and the International Olympic Committee (IOC) recommend resting electrocardiograms for all young athletes before they are allowed to compete.

The Journal of American College of Cardiology last year featured an article titled “Mandatory Electrocardiographic Screening of Athletes to Reduce Their Risk for Sudden Death: Proven Fact or Wishful Thinking?” that suggests the latter. The study analyzed the incidence of sudden death among competitive athletes following the enactment of the 1997 National Sport Law, which mandates screening of all athletes with resting ECG and exercise testing. The study found that there were 24 documented events of sudden death or cardiac arrest events among competitive athletes during the years 1985 through 2009, with 11 occurring before the 1997 legislation and 13 occurring after it. According to the study, the average yearly incidence of sudden death or cardiac arrest events was 2.6 events per 100,000 athlete-years. The study concluded that mandatory ECG screening of athletes had no apparent effect on their risk for cardiac arrest.  The authors suggested that the higher incidence of sudden death found in the Italian studies was not representative of the sudden death risk in the athlete population of most other countries [including the United States] which have a much lower incidence.

What does this mean? Johann von Goethe, a German poet, playwright, novelist, and natural philosopher, said: “Knowing is not enough; we must apply.” As the latest cardiac-related death of an athlete makes headlines, it is our job to take our knowledge and make sure we continue to educate not only each other, but our primary care colleagues as well, about what to look for and the questions to ask when screening young athletes. Most importantly we need to make sure primary care providers know when to refer for EKGs.  Patient education is also key. It’s critical that young athletes understand the warning signs and know when to seek help. Promoting the availability of AED’s at athletic events is also key, serving as a less costly alternative to mandatory ECGs that is proven to save lives if used immediately.

Moving forward, the College’s Sports and Exercise Cardiology Council and Section is an important resource for cardiovascular professionals who work with and or treat athletes. The goal of the section and council is to serve as a conduit for information and action regarding the cardiovascular care of athletes, and support constructive and enhanced interactions with all interested stakeholders. We are also participating in the dialogue regarding public policy around issues specific to the cardiovascular care of athletes and exercising individuals and are looking at enhancing opportunities for multidisciplinary training to improve interpretation cardiac testing in athletes and exercising individuals.

Also earlier this week the Sports and Exercise Cardiology Council worked with The New York Times to get a correction to an article “Should Young Athletes Be Screened for Heart Risk?” Read the article including a comment by Christine Lawless, MD, FACC and Richard Kovacs, MD, FACC here.

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