Cardiovascular Screening of Elite Athletes by Sporting Organizations in Australia: A Survey of Chief Medical Officers

Abstract

Objective: To compare cardiovascular screening policies of Australian elite sporting organizations. Design: Online survey. Setting: Elite/professional sports in Australia. Participants: Chief medical officers (CMOs) of elite/professional sports in Australia, including rugby union and league, cricket, tennis, Australian football, and cycling. Assessment of Variables: Survey questions about each sport's cardiac screening policy: which screening components were included [eg, history and physical (H&P), resting 12-lead electrocardiogram (ECG)], whether screening was mandatory, whether the policy applied to elite junior and/or adult players, and which criteria were used to interpret ECGs. Main Outcome Measures: Which sports had a formal cardiac screening policy, which athletes the policy applied to, components of screening, ECG interpretation criteria used. Results: Chief medical officers for 22/31 (71%) sports responded, representing >5000 athletes. Of these, 19/22 (86%) perform regular screening (100% H&P; 89% included ECG) with international cyclists also having routine echocardiograms and stress testing. Thirty-three percent of CMOs used the 2017 International Criteria for athlete ECG interpretation. Screening was mandatory with enforcement (26%), mandatory without enforcement (48%), and opt-out (26%). All screened adult elite athletes, and 68% screened junior elite athletes. Forty-two percent indicated athletes were required to pay for screening tests, and 63% required athletes to pay for follow-up tests. Almost all (94%) sports with a sports physician as the CMO screened athletes. Conclusions: Most sports have a screening policy, with reasonable uniformity of components. All included H&P, and almost all included ECG. Only one sport included an echocardiogram and stress test as a standard (international players only). Promoting the latest ECG interpretation criteria may reduce false-positives and cost. Future work should explore cardiac emergency plans, screening infrastructure, cost, and long-term follow-up.

Team Approach: Diagnosis, Management, and Prevention of Sudden Cardiac Arrest in the Athlete

“…As such, the decision to incorporate noninvasive cardiac testing into preparticipation evaluation ultimately depends on the resources available in a given practice setting, the availability of clinicians with expertise in interpretation of diagnostic tests in the athletic population, the organization and societal tolerance for false positives and negatives, and the athletic population being evaluated. Given the differential impact of these variables at the elite/professional level, most elite/professional organizations include an ECG interpreted through the 2019 International criteria 36 .…”

The Impact of Ethnicity on Athlete ECG Interpretation: A Systematic Review

“…Despite the high level of physical fitness of athletes, sudden cardiac death is a rare but tragic occurrence that is 2.5 times more likely in elite athlete populations than age-matched young populations [ 2 ]. Preparticipation cardiac screening of athletes is, therefore, now commonly recommended at the elite level, with the aim of minimizing the risk of sudden cardiac death [ 3 , 4 ]. Screening generally includes a history and physical examination and a resting 12-lead electrocardiogram (ECG) [ 3 , 4 ].…”

“…Preparticipation cardiac screening of athletes is, therefore, now commonly recommended at the elite level, with the aim of minimizing the risk of sudden cardiac death [ 3 , 4 ]. Screening generally includes a history and physical examination and a resting 12-lead electrocardiogram (ECG) [ 3 , 4 ].…”

Olympic Cycle Comparison of the Nutritional and Cardiovascular Health Status of an Elite-Level Female Swimmer: Case Study Report from Slovenia

“…At the elite level, various major international sports governing bodies (e.g., Fédération Internationale de Football Association and the International Olympic Committee) are performing, requiring, or recommending CV screening [ 19 ]. In addition, athletes may have an increased risk of CV disease later in life (e.g., of note, CV diseases may start early in life [ 20 , 21 , 22 ]), although data on the association between elite-level sports participation and CV health remain largely inconclusive [ 23 , 24 , 25 , 26 ].…”