Fears of heart risks drive new interest in EKG screening for kids

Why it matters: While rare, sudden cardiac death is still the top medical cause of death in athletes, with research showing between 1 in 40,000 and 1 in 80,000 athletes die from the condition each year.

• With roughly 8 million teen athletes playing organized sports in the U.S. each year, advocates say expanding the use of the relatively low-cost, non-invasive intervention could save lives.
• Despite the rising interest, organizations like the U.S. Preventive Services Task Force and American Academy of Family Physicians continue to recommend against such screening for low-risk individuals without symptoms, citing little evidence that would improve health outcomes.

Driving the news: A recent study of 11,500 student athletes in central Florida found about 3% of teens who received an EKG had an abnormal heart finding.

• The study, led by Nemours Children's Hospital in Orlando, had follow-up data from 105 of those students. Researchers found 14 had an underlying cardiovascular disease that could predispose them to cardiac arrest.
• "If you take a screening with just their traditional physical exam and history, you're gonna miss more than 75% of them with underlying disease," Gul Dadlani, division chief of pediatric cardiology at Nemours and lead author of the study, told Axios.
• EKGs can't catch everything, he pointed out. But they can detect conditions such as hypertrophic cardiomyopathy, in which the heart thickens inappropriately due to a genetic defect, as well as Wolff-Parkinson-White syndrome, in which an extra pathway in the heart allows it to go into a rapid rhythm, he said.
• "As a parent, why wouldn't you want to know if your child had a risk of sudden cardiac arrest before they stepped onto that field?" Dadlani said.

The big picture: In Florida, parents are working with state lawmakers on legislation that would make EKGs for student athletes mandatory. Multiple county school districts already require them.

• If passed, it appears that would be the furthest any state has gone to promote EKGs for student athletes. And it's part of growing efforts across several states to increase awareness around cardiac arrest and the use of the screening.
• As student athletes returned to the practice field in recent weeks, nonprofits largely started by families of teens who'd suffered sudden cardiac arrest have been providing low- or no-cost screening to thousands of teens in Kentucky, Michigan, New York, Pennsylvania and Texas.
• At least 18 states — Alabama and Wisconsin among the most recent — now require that families of student athletes be informed about cardiac arrest and available testing.
• Earlier this year, Wisconsin Gov. Tony Evers also proposed providing roughly $4.1 million to implement an EKG screening program for kids in sports.

Zoom in: In 2007, Ralph Maccarone was on his way to pick up his son Rafe, a soccer player at Cocoa Beach High School, when he got a call from the coach telling him to get to the field immediately.

• "There was silence on the other end of the phone and I just assumed, you know, that he'd passed out or had heat exhaustion. I had no clue," Maccarone told Axios.
• Instead, he learned Rafe had suffered from sudden cardiac arrest during practice. He died the next day.
• Maccarone and some of Rafe's teammates began the nonprofit Who We Play For, one of multiple organizations around the U.S. pushing for improved protections against sudden cardiac death for students. The organization lobbied successfully for a law in Florida to make CPR training a graduation requirement.
• They've also donated hundreds of automated external defibrillators, or AEDs, to local clubs across the state and have provided EKG screening at a low cost to more than 250,000 kids.

The other side: Among the reasons organizations like the American Heart Association do not recommend mandatory participation in EKG screening is that such testing can "mistakenly suggest a problem that requires more extensive testing to eliminate, and meanwhile, sidelines athletes who aren't actually at risk," a spokesperson said in an email to Axios.

• Studies have shown as many as a third of athlete EKGs may result in these so-called false positives, and the testing can also often miss critical findings and send back a false negative.
• Cost is also an issue to consider, Cheyenne Beach, a pediatric cardiologist at Yale Medicine, said earlier this year.
• "While a single ECG is not very expensive, the cost of screening all children adds up quickly and is not yet something that can be done universally," Beach said.