Opt-in Electrocardiogram Screening at High-School Physicals Does Not Identify Those at Highest Risk for Sudden Cardiac Death

Pre-participation examination (PPE) is mandatory for United States high school athletes. Despite evidence suggesting increased detection of cardiac disease associated with sudden cardiac death (SCD), obtaining a resting 12-lead electrocardiogram (ECG) is not required for pre-participation evaluation. We queried local high school athletes undergoing PPE between 2017-2019 to gauge interest in having an ECG performed during their PPE. We also evaluated willingness to pay for an ECG and potentially other tests if screening ECG is abnormal. There were 149 respondents, of whom 104 (70%) were male. 18 (12%) respondents were African American (AA) and 30 (20%) played basketball. Regarding interest in ECG, 77 (52%) were unsure, 41 (28%) responded ‘yes’ and 31 (21%) responded ‘no’. Of those not interested in ECG, 11 (35%) played basketball, 23 (74%) were male and 5 (16%) were AA. Basketball players were less likely to want an ECG (p-value 0.002). 48 athletes responded that they would pay for an ECG, 3 (6%) of whom were AA. 46 responded that they would not pay, 13 (28%) of whom were AA (p-value 0.005). Most athletes and parents were unsure about ECG screening. Among athletes considered highest risk for SCD (males, AA and basketball players), there was disproportionately lower interest in screening or paying for an ECG. Lack of interest might be for many reasons, including lack of knowledge regarding the utility of ECG screening and financial considerations. Our study showed that opt-in ECG screening at PPE would miss many high school athletes at highest risk.