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EKG Screening for College Athletes (New York Times)

By January 29, 2016November 28th, 2022News

Jan 26, 2016- New York Times

By: Sandeep Jauhar

LAST March, the N.C.A.A.’s chief medical officer, Brian Hainline, announced that he was going to recommend that all male college basketball players undergo an electrocardiogram, which measures the electrical activity in the heart, presumably as a requirement for being cleared to play competitively. He said his action was in response to research suggesting that the risk of sudden cardiac death in Division I basketball players was about one in 5,200 per year, much higher than previously thought.

Those are legitimate concerns, but Dr. Hainline’s original proposal was the right one: We should begin targeted screening of some groups of college athletes — starting with those in sports that recent research indicates pose a high cardiovascular risk, such as basketball and soccer.

The N.C.A.A. is currently developing guidelines for managing sudden cardiac arrest in its athletes. Expected to be released later this year, the guidelines are likely to endorse a standardized questionnaire on medical and family history, more training in CPR and increased access to automatic defibrillators. However, they will almost surely not include EKG screening.

Several important organizations, including the European Society of Cardiology, the International Olympic Committee and FIFA, soccer’s governing body, recommend EKG testing for competitive athletes. But in the United States, EKG screening is reserved only for professional athletes. (Italy and Israel mandate EKGs for collegians also.) It is a disparity that needs to be examined closely. Nothing suggests that college athletes are at any lower risk of sudden cardiac death than professionals.

Dr. Hainline’s proposal came 25 years after perhaps the most famous incident of sudden death in college sports. On March 4, 1990, the Loyola Marymount University basketball star Hank Gathers collapsed while playing in a game against the University of Portland. His body convulsed on the hardwood floor, and despite shocks from a defibrillator, he could not be revived. He was pronounced dead at a hospital shortly after.

Mr. Gathers’s sudden death was never fully explained, though some media reports suggested he had hypertrophic cardiomyopathy, an abnormally thickened heart that is the most common cause of sudden death in young athletes. Hypertrophic cardiomyopathy is a heritable condition. Three years after Mr. Gathers died, his first cousin, a high school senior, also died while playing basketball.

Heart disorders like hypertrophic cardiomyopathy are often detectable by a standard electrocardiogram. However, the American Heart Association and the American College of Cardiology are strongly opposed to routine EKG screening. Barry Maron, a Minneapolis cardiologist who was the chief author of a recent position statement by these organizations, argues that because of the low incidence of heart disease in young people, he believes the false positive rate will be too high — between one in three and one in seven, by some estimates.

But of course this tragedy pales before the tragedy of sudden death. Unfortunately there is no consensus on the incidence of sudden death in college athletes. Dr. Maron puts the rate between one in 50,000 and one in 100,000. However, research published last year in the journal Circulation by Dr. Kimberly Harmon and her colleagues found that the cumulative risk over a typical four-year career of a Division I male basketball player was a staggering 1 in 1,300, higher than his risk of dying in an automobile accident.
Some experts, including Dr. Maron, dispute this latest data, saying that it spuriously counts deaths from other causes, such as drug overdoses. But if it is correct, the incidence of sudden death is high enough to justify EKG or even ultrasound screening. Despite the N.C.A.A.’s own position, some individual college programs already require their athletes to undergo either test. A few require both.

There are about eight million high school and 460,000 college athletes in this country. Screening all these young people with EKGs will not be feasible. Many communities do not have experts available to properly interpret EKGs in well-conditioned athletes. Cost is also a consideration. Screening all these athletes would most likely cost billions of dollars.

But targeted screening of higher risk groups, such as basketball and soccer players, makes sense. In the final analysis it is a moral judgment. Are the anxieties and associated costs of false positives outweighed by that rare life that might be saved? Though we still need more study of this issue, we should, in the meantime, begin to screen the highest-risk college athletes.