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Am Fam Physician. 2007;75(10):1549-1552

Background: Sudden death in young athletes most commonly occurs secondary to previously undiagnosed heart disease, including hypertrophic cardiomyopathy and arrhyth-mogenic right ventricular cardiomyopathy. Preparticipation screenings may be helpful in detecting disease and preventing deaths. In Italy, the preparticipation sports examination includes 12-lead electrocardiography (ECG). This study compared mortality rates from sudden cardiovascular death in screened athletes and an unscreened, nonathlete population.

The Study: The competitive athletes were 12 to 35 years of age, with similarly aged unscreened nonathletes serving as the control group. The study focused on annual incidences of sudden cardiovascular death between 1979 and 2004, and any changes that occurred after the mandatory preparticipation screening program was introduced in 1982. The authors considered three screening periods: prescreening (1979 to 1981), early screening (1982 to 1992), and late screening (1993 to 2004). Sudden death was defined as unexpected death from natural causes occurring immediately or within one hour of the initial collapse. Cardiac causes were identified at a postmortem examination. Screening included a personal history, a family history, physical examination, and results of 12-lead ECG.

Results: Overall, 55 cases of sudden cardiovascular death occurred in the screened population during the study, which encompassed 2,938,730 person-years. Of these deaths, 50 were in males and five were in females. The accompanying table illustrates the average incidence of sudden death in the three study periods, representing a 44 percent decrease from the first to second screening period and a 63 percent decrease from the second to third period. In the nonathlete group, there were 265 sudden deaths with no significant changes in incidence over the study periods.

Prescreening (1979 to 1981)4.190.77
Early screening of athletes with history, physical, ECG (1982 to 1992)2.350.79
Late screening of athletes with history, physical, ECG (1993 to 2004)0.870.81

Decline in death was due to fewer deaths from cardiomyopathies, especially arrhyth-mogenic right ventricular cardiomyopathy. Of the 55 athletes who died, 24 (44 percent) had positive findings on the history, physical examination, or ECG, although all were cleared for participation in sports. Of the athletes who were screened, 9 percent were referred for additional testing, and 2 percent were ultimately disqualified. Of note, a higher proportion of athletes were disqualified over time because of an increased diagnosis of arrhythmogenic right ventricular cardiomyopathy.

Conclusion: The authors conclude that there was a documented decline in sudden cardiovascular death associated with implementation of a preparticipation screening program, with an 89 percent decrease in sudden cardiovascular death in the study group and increasing identification and disqualification of athletes with cardiomyopathy. At the same time, there was no change in death rates from sudden cardiovascular death in a comparable unscreened, nonathlete population.

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