Athletes rarely die from sudden unsuspected cardiovascular
disease, but the local community is shocked when it happens. Cardiovascular screening
is now a standard part of athletic physicals to help protect athletes from unexpected death, triggered by intense physical
activity, but its effectiveness is sometimes questionable. The success of preventative
screening depends on how thorough it is and the qualifications of the people performing the physical.
Pfister,
et al. (2000), surveyed all NCAA schools to learn how thoroughly they screen their athletes for cardiovascular problems. Four years ago, they published their findings in The
Journal of the American Medical Association. The methods used by institutions
in their screening processes were compared to the American Heart Association’s (AHA) twelve guidelines for the screening
of athletes:
·
Family history of:
o premature or sudden death
o heart disease in surviving relatives
·
Personal history of:
o heart murmur
o systemic hypertension
o excessive fatigue
o exertional syncope
o exertional chest pain
o excessive exertional shortness
of breath
·
Physical examinations for:
o heart murmur
o femoral pulses
o stigmata of Marfan syndrome
o Blood pressure measurement
A physical that
encompasses all twelve of these guidelines will detect most athletes who have a genetic predisposition to cardiovascular problems. Since most schools do not test for all twelve symptoms, researchers “arbitrarily
regarded as adequate” a physical that includes nine out of these twelve. An
inadequate physical increases the risk of not catching a susceptible athlete.
The
study was also concerned with the personnel performing the physical because they play an important role in finding a potential
defect. Orthopedic surgeons are usually responsible for performing athletic physicals
because they can specialize in sports medicine. Ideally, a physician specializing
in cardiology or primary care should perform screening for heart defects since they are experts in cardiovascular screening. However, since orthopedic surgeons are at least familiar with the screening process,
they are suitable alternatives. Because nurses and athletic trainers do not have
extensive training, they need to be supervised by a physician.
Of the schools that responded to the survey,
97% said that formal screening is an “absolute requirement” prior to participation in varsity intercollegiate
sports (51% required annual screening, and 49% required screening only upon college entry).
However, only 26% of these schools had physical forms that were considered adequate by containing at least nine out
of twelve AHA-recommended items while 24% had four or fewer items. Evidence like
this indicates that a majority of schools are not aware of what constitutes adequate screening.
Team
physicians were used by 85% of the schools, and 75% of these were orthopedic surgeons who are not as familiar with the cardiovascular
screening process as cardiologists or primary care physicians. A “substantial”
but unspecified number of institutions used nurse practitioners or athletic trainers to perform the physicals. Some performed them alone or under the supervision of a physician.
This evidence shows that colleges and universities need to set standards for those performing the physicals so that
athletes can receive expert screening.
Athletes
at Duke are cared for the Duke Sports Medicine Center. They have access to ten
trainers and five physicians. Three of the five physicians are orthopedic surgeons;
one is a pediatric specialist; one is a family care specialist (Duke University Athletic Training Services). The center provides care for women's sports medicine,
pediatric sports medicine, sports psychology, primary care/non-orthopedic related medical care
and rheumatology care. It also works with medical illnesses related to sports activity such as asthma, concussion
and post-concussion syndrome, mononucleosis, athletic-induced amenorrhea and overtraining syndrome (Duke Sports Medicine
Center). Preventative cardiovascular screening is not mentioned, so while Duke
provides extensive care for range of sports related injuries and illnesses, it may not provide the adequate screening for
heart conditions.
The findings of Pfister, et al. indicate that
improvements need to be made in how colleges care for their athletes’ health.
In order to prevent unnecessary deaths, institutions need to commit to proper screening protocols. Annual screening that includes at least nine out of the AHA’s twelve guidelines is necessary. The screening needs to be performed by individuals who have the most expertise in
heart screening. If these guidelines are followed, there is the potential to
reduce the number of sudden unexpected deaths among college athletes.
References
Pfister,
Glen C. BS, James C. Puffer MD, and Barry J. Maron MD. 2000 "Preparticipation
Cardiovascular Screening for US Collegiate Student-Athletes." The Journal of the American
Medical Association Vol 283 (12): 1597-1599
Duke Sports Medicine Center. April 28, 2004
http://www.dukesportsmedicine.com/