American Medical Society for Sports Medicine
AMSSM Produces Position Statement on Cardiovascular Screening in Athletes
Leawood, KS – AMSSM is pleased to announce the release of the AMSSM Position Statement on Cardiovascular Preparticipation Screening in Athletes: Current Evidence, Knowledge Gaps, Recommendations and Future Directions.
AMSSM formed a task force to address the controversial topic of cardiovascular screening in athletes and the potential addition of an electrocardiogram (ECG) to the standard history and physical examination. The position statement presents several new paradigm shifts in our thinking about cardiovascular screening in athletes – namely a reassessment of our current standard, recognition of the differential risk of sudden cardiac arrest and death (SCA/D) in different athlete populations, a new framework to assist physicians when considering a screening ECG and respect for physician autonomy to choose the most appropriate screening strategy. Developed by an expert panel of primary care sports medicine physicians representing all perspectives on cardiovascular screening, the statement provides a balanced assessment of the current evidence and knowledge gaps regarding cardiovascular screening in athletes. The position statement is concurrently being published in the Clinical Journal of Sport Medicine, the British Journal of Sports Medicine, and Current Sports Medicine Reports.
The primary goal of cardiovascular screening in competitive athletes is to identify cardiac disorders at elevated risk of SCA/D and to reduce morbidity and mortality through individualized and disease-specific management. The current pre-participation history and physical examination, while pragmatic and widely practiced, is limited in its ability to identify athletes with conditions at risk for SCA/D.
ECG screening does offer enhanced detection of cardiac disorders at potential risk of SCA/D, but it also increases the potential for false-positive results and the associated downstream consequences. “Evidence suggests medical management can reduce the risk of sudden death for several of the cardiac disorders we are looking for. The question is whether we can accomplish early detection and proper management without causing undue harm,” said Jonathan Drezner, MD, lead author and co-chair of the statement and an AMSSM Past President. In choosing a screening strategy, sports medicine physicians should consider the individual risk of the athlete, physician expertise and available cardiology resources for accurate ECG interpretation and the secondary evaluation of ECG abnormalities, as well as their assessment that a particular screening strategy will provide more benefit than harm.
“In the absence of clear evidence, we must respect physician autonomy to implement the most appropriate screening strategy unique to their athlete population and community resources,” stated Fran O’Connor, MD, MPH, also co-chair of the statement and an AMSSM Past President. Widely practiced and accepted screening standards are not perfect and should undergo continual revision as new data emerges.
ECG screening is often framed as a choice between universal, mandatory screening or no screening at all. “A single, universal strategy or ‘one-size-fits-all’ model may not be appropriate for all athletes or all physicians,” Drezner added. Accordingly, AMSSM supports continued research in this area to validate the optimal strategies for reducing SCA/D in athletes.
The position statement can be viewed by visiting the AMSSM website, http://www.amssm.org/Publications.html.
To schedule an interview with Dr. Drezner or Dr. O’Connor, contact Communications Manager Andy Meyer at 913-327-1415, ext. 57.
About the AMSSM: AMSSM is a multi-disciplinary organization of 3,000 sports medicine physicians dedicated to education, research, advocacy and the care of athletes of all ages. The majority of AMSSM members are primary care physicians with fellowship training and added qualification in sports medicine who then combine their practice of sports medicine with their primary specialty. AMSSM includes members who specialize solely in non-surgical sports medicine and serve as team physicians at the youth level, NCAA, NFL, MLB, NBA, WNBA, MLS and NHL, as well as with Olympic teams. By nature of their training and experience, sports medicine physicians are ideally suited to provide comprehensive medical care for athletes, sports teams or active individuals who are simply looking to maintain a healthy lifestyle. www.amssm.org.
NOTE: For more information, please contact the AMSSM, 4000 W. 114th St., Suite 100, Leawood, KS 66211, (913) 327-1415.