Systematic echocardiography is not efficacious when screening an ethnically diverse cohort of athletes in West Asia

Nathan R. Riding, Sanjay Sharma, Othman Salah, Nelly Khalil, François Carré, Keith P. George, Bruce Hamilton, Hakim Chalabi, Gregory P. Whyte, Mathew G. Wilson

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

Background: The clinical and economic value of including systematic echocardiography (ECHO) alongside the 12-lead electrocardiograpm (ECG) when undertaking pre-participation screening in athletes has not been examined, yet several sporting organistations recommend its inclusion. Design: To examine the efficacy of systematic ECHO alongside the ECG, to identify sudden cardiac death (SCD) disease and to provide a cost-analysis of a government-funded pre-participation screening programme. Methods: A total 1628 athletes presented for cardiological consultation, ECG, and ECHO as standard, with further cardiac examinations performed if necessary to confirm or exclude pathology. The efficacy of systematic ECHO was compared to an ECG-led programme, with ECHO reserved as a follow-up examination. Results: To screen 1628 athletes with ECG and ECHO cost US$743,996. There were 54 24-h-blood pressure/ECG Holter recordings, 62 exercise tests, 25 CMRs, two electrophysiological studies, and two genetic tests, which cost US$67,734: total US$811,730. Eight athletes (0.5%) were identified with hypertrophic cardiomyopathy (HCM) and two (0.1%) with Wolff-Parkinson-White syndrome. The cost per identifed athlete was US$81,173. All 10 athletes presented an abnormal ECG. No athlete diagnosed with HCM was identified by ECHO in isolation. When adopting a ECG-led screening protocol, 15% of athletes required ECHO as a follow-up examination, resulting in a US$380,600 cost reduction (47% saving), with the cost per diagnosis reduced to US$43,113. Conclusions: Athletes diagnosed with a disease associated with SCD were identified via an abnormal ECG and/or physical examination, personal symptoms, or family history. Screening athletes with systematic ECHO is not economically or clinically effective.

Original languageEnglish
Pages (from-to)263-270
Number of pages8
JournalEuropean Journal of Preventive Cardiology
Volume22
Issue number2
DOIs
Publication statusPublished - 17 Feb 2015
Externally publishedYes

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Athletes
Echocardiography
Costs and Cost Analysis
Hypertrophic Cardiomyopathy
Sudden Cardiac Death
Wolff-Parkinson-White Syndrome
Exercise Test
Physical Examination
Heart Diseases
Referral and Consultation
Economics
Pathology
Blood Pressure

Cite this

Riding, Nathan R. ; Sharma, Sanjay ; Salah, Othman ; Khalil, Nelly ; Carré, François ; George, Keith P. ; Hamilton, Bruce ; Chalabi, Hakim ; Whyte, Gregory P. ; Wilson, Mathew G. / Systematic echocardiography is not efficacious when screening an ethnically diverse cohort of athletes in West Asia. In: European Journal of Preventive Cardiology. 2015 ; Vol. 22, No. 2. pp. 263-270.
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abstract = "Background: The clinical and economic value of including systematic echocardiography (ECHO) alongside the 12-lead electrocardiograpm (ECG) when undertaking pre-participation screening in athletes has not been examined, yet several sporting organistations recommend its inclusion. Design: To examine the efficacy of systematic ECHO alongside the ECG, to identify sudden cardiac death (SCD) disease and to provide a cost-analysis of a government-funded pre-participation screening programme. Methods: A total 1628 athletes presented for cardiological consultation, ECG, and ECHO as standard, with further cardiac examinations performed if necessary to confirm or exclude pathology. The efficacy of systematic ECHO was compared to an ECG-led programme, with ECHO reserved as a follow-up examination. Results: To screen 1628 athletes with ECG and ECHO cost US$743,996. There were 54 24-h-blood pressure/ECG Holter recordings, 62 exercise tests, 25 CMRs, two electrophysiological studies, and two genetic tests, which cost US$67,734: total US$811,730. Eight athletes (0.5{\%}) were identified with hypertrophic cardiomyopathy (HCM) and two (0.1{\%}) with Wolff-Parkinson-White syndrome. The cost per identifed athlete was US$81,173. All 10 athletes presented an abnormal ECG. No athlete diagnosed with HCM was identified by ECHO in isolation. When adopting a ECG-led screening protocol, 15{\%} of athletes required ECHO as a follow-up examination, resulting in a US$380,600 cost reduction (47{\%} saving), with the cost per diagnosis reduced to US$43,113. Conclusions: Athletes diagnosed with a disease associated with SCD were identified via an abnormal ECG and/or physical examination, personal symptoms, or family history. Screening athletes with systematic ECHO is not economically or clinically effective.",
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Riding, NR, Sharma, S, Salah, O, Khalil, N, Carré, F, George, KP, Hamilton, B, Chalabi, H, Whyte, GP & Wilson, MG 2015, 'Systematic echocardiography is not efficacious when screening an ethnically diverse cohort of athletes in West Asia', European Journal of Preventive Cardiology, vol. 22, no. 2, pp. 263-270. https://doi.org/10.1177/2047487313506549

Systematic echocardiography is not efficacious when screening an ethnically diverse cohort of athletes in West Asia. / Riding, Nathan R.; Sharma, Sanjay; Salah, Othman; Khalil, Nelly; Carré, François; George, Keith P.; Hamilton, Bruce; Chalabi, Hakim; Whyte, Gregory P.; Wilson, Mathew G.

In: European Journal of Preventive Cardiology, Vol. 22, No. 2, 17.02.2015, p. 263-270.

Research output: Contribution to journalArticle

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T1 - Systematic echocardiography is not efficacious when screening an ethnically diverse cohort of athletes in West Asia

AU - Riding, Nathan R.

AU - Sharma, Sanjay

AU - Salah, Othman

AU - Khalil, Nelly

AU - Carré, François

AU - George, Keith P.

AU - Hamilton, Bruce

AU - Chalabi, Hakim

AU - Whyte, Gregory P.

AU - Wilson, Mathew G.

PY - 2015/2/17

Y1 - 2015/2/17

N2 - Background: The clinical and economic value of including systematic echocardiography (ECHO) alongside the 12-lead electrocardiograpm (ECG) when undertaking pre-participation screening in athletes has not been examined, yet several sporting organistations recommend its inclusion. Design: To examine the efficacy of systematic ECHO alongside the ECG, to identify sudden cardiac death (SCD) disease and to provide a cost-analysis of a government-funded pre-participation screening programme. Methods: A total 1628 athletes presented for cardiological consultation, ECG, and ECHO as standard, with further cardiac examinations performed if necessary to confirm or exclude pathology. The efficacy of systematic ECHO was compared to an ECG-led programme, with ECHO reserved as a follow-up examination. Results: To screen 1628 athletes with ECG and ECHO cost US$743,996. There were 54 24-h-blood pressure/ECG Holter recordings, 62 exercise tests, 25 CMRs, two electrophysiological studies, and two genetic tests, which cost US$67,734: total US$811,730. Eight athletes (0.5%) were identified with hypertrophic cardiomyopathy (HCM) and two (0.1%) with Wolff-Parkinson-White syndrome. The cost per identifed athlete was US$81,173. All 10 athletes presented an abnormal ECG. No athlete diagnosed with HCM was identified by ECHO in isolation. When adopting a ECG-led screening protocol, 15% of athletes required ECHO as a follow-up examination, resulting in a US$380,600 cost reduction (47% saving), with the cost per diagnosis reduced to US$43,113. Conclusions: Athletes diagnosed with a disease associated with SCD were identified via an abnormal ECG and/or physical examination, personal symptoms, or family history. Screening athletes with systematic ECHO is not economically or clinically effective.

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