Should young athletes be monitored?

Should young athletes be monitored? (Teo Lannie, PhotoAlto via Getty Images)

Other European countries have followed Italy's lead and implemented ECG screening for young athletes. A study group for the European Society of Cardiology determined the evidence warrants such tests.

Danish cardiologists broke from the European Society of Cardiology on screening, Holst said. He went on to compare ECGs to prostate-specific antigen tests for prostate cancer. U.S. and European doctors intuitively thought PSA tests would save lives long before there was much evidence, he said. Yet recent reports, including one from a U.S.-wide trial, have suggested the harm of over-treatment may not be worth any small potential screening benefit.

Finding answers

Researchers would need a "gold standard" trial — in which young athletes are randomly assigned to have ECGs or not — to determine if screening is worthwhile, Holst said.

That would require a huge number of athletes and decades of follow-up.

"It's not feasible in my view," he said.

Cardiologist Dr. Robert Myerburg from the University of Miami Miller School of Medicine doesn't support waiting for that persuasive data.

"I think we ought to implement (screening)," he said. "Some number of deaths can be prevented as we're going along, as we're doing the research."

Organizing a federal screening program probably isn't realistic in the U.S., Myerburg said, but individual states can start screening high school athletes, he suggested.

Dr. Joseph Marek, a cardiologist from the Midwest Heart Foundation in Oakbrook Terrace, Ill., who directs the screening program that tested Christopher Storm, said communities can sponsor in-school screening if local cardiologists are willing to volunteer to save money.

Without them, adding an ECG screening program to a traditional history and physical would cost $117 per athlete, or about $69,000 per "quality" year of life saved, according to the National Institutes of Health. The bar for cost-effectiveness is typically considered to be $50,000 per quality life-year saved.

Using a lower ECG price, Stanford researchers said screening could be cost-effective. According to their model, if the 3.7 million student-athletes deemed to be potentially at risk were screened, 183,000 would be referred for further testing. One in six of those would get results confirming a heart problem. The cost would be just under $43,000 per life-year saved.

Depending on the particular abnormality, treatment can include heart medications, surgery or exercise restrictions only.

For Storm's condition, doctors placed an implantable cardioverter defibrillator and pacemaker in his chest to keep his heartbeat regular.

He's allowed to exercise as long as his heart rate stays below 155 beats per minute. He can't run competitively but plays pickup basketball with his friends, who let him stay on one half of the court.

"The biggest thing for me is, I'm always hearing about the athletes who collapse on the court or on the field … from the exact same thing that I have," Storm said.

The American Heart Association recommends only a physical and medical history for kids starting sports.

"I certainly understand the desire to want to do something, but we need to be cautious about that," said Dr. Jonathan Kaltman, a medical officer at the National Heart, Lung, and Blood Institute in Bethesda, Md.

"We need to be able to confidently say that we're doing more good than harm before launching a screening program that's going to affect many, many lives."