81 The Financial Implications of Application of the Refined ECG Criteria in Pre-Participation Screening of Elite Athletes. (6th June 2015) - Dhutia, Harshil
Abstract : Introduction: Sudden cardiac death in young athletes is commonly due to inherited cardiac diseases that can be detected during life. The International Olympic Committee (IOC) and European Society of Cardiology (ESC) recommend pre-participation screening with ECG in young athletes to detect those at risk. The 2010 ESC recommendations and Seattle criteria recommendations were developed to aid the ECG interpretation in athletes given that cardiovascular remodelling in the conditioned athlete is associated with physiological ECG changes. Antagonists of ECG inclusive pre-participation screening have questioned the high rates of false positive ECG's in athletes despite these recommendations, as well as the cost effectiveness of such practice. The recently published refined criteria for ECG interpretation in athletes have demonstrated a significant reduction in the false positive ECG rate without compromising sensitivity of diagnosis. The aim of this study was to report the financial implications of application of the three ECG interpretation criteria in detecting potentially sinister diseases in young UK athletes. Methods: Between 2011–2013, 2, 493 consecutive asymptomatic and apparently healthy elite athletes aged 14–35 years underwent pre-participation screening with ECG conducted by a cardiologist at a cost of £35 per athlete. ECG interpretation was in line with 2010 ESC recommendations. Athletes with ECG abnormalities warranted further evaluation which would be facilitated in secondary care as recommended by the ESC. The Seattle criteria and refined criteria for ECG interpretation were applied to this cohort retrospectively. Results: 2, 493 athletes (mean age 19.8 ± 4 years, 1934 (78%) male, 2, 214 white (88.9%), 72 black (3%), 227 mixed/other (8.1%)) from 23 sporting disciplines were screened. 7 athletes (0.3%) were diagnosed with a potentially sinister cardiac condition by ECG irrespective of the ECG criteria used (4 HCM, 1 LQTS, 2 WPW). The refined criteria would reduce the minimum overall cost per sinister cardiac condition identified from £31, 191 to £17, 459, equating to a 44% reduction. Conclusion: The refined criteria for ECG interpretation could reduce the overall cost of pre-participation screening by a minimum by £39 per athlete (Table 1 ). In the current financial climate, the refined criteria provides a welcome cost saving practice without compromising efficacy of screening. The data is based on heavily subsidised preliminary investigations and modest tariffs of further investigations in the National Health Service (NHS); therefore the refined criteria is likely to have a greater impact in other healthcare models.