A recent survey conducted in Washington found less than half of doctors and only 6 percent of athletic directors were aware of the national guidelines for sudden cardiac death risk assessment, and less than 6 percent of doctors fully followed them.
In 2007, the American Heart Association reaffirmed a set of guidelines previously established in 1996, aimed at reducing the number of athletes who die as a result of sudden cardiac arrest, which can occur within minutes of onset. Currently, one out of every 30,000 to 50,000 high school student-athletes are estimate to die each year as result of sudden cardiac arrest, spurring a push for mandatory installation of life-saving automatic external defibrillators (AEDs) in high schools.
In the survey, sent to more than 2,000 participants, doctors were asked about their conduct of pre-sports physicals and athletic directors about their schools' requirements for physicals. Though the guidelines recommend physicians ask about eight specific questions about medical history and perform four key physical exam elements, the survey results found that doctors did not always ask the complete set of medical history questions, omitting questions about chest pain during exercise, unexplained fainting, family history of early death and family history of heart disease.
The study highlights the need for greater awareness of national guidelines, and survey participants unanimously supported the formation of a statewide standardized form incorporating the AHA recommendations. Requiring a more complete pre-participation assessment would help doctors identify at-risk athletes and order follow up tests, such as electrocardiograms. Such tests are already requirement for student-athletes in Italy and commonplace throughout Europe. Currently, schools in Washington do not require any sort of pre-participation cardiac risk assessment, according to the athletic directors who responded.
Dr. Nicolas Madsen, a pediatric cardiology fellow at Seattle Children's Hospital and the University of Washington School of Medicine and the study's lead author, stressed the need for provider education and school policy requirements to increase awareness and compliance with the guidelines. Parents are also encouraged to do their part by asking whether schools offer a standardized pre-participation form that includes cardiac assessment.
