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Few Doctors Following Guidelines for Screening Young Athletes' Hearts

Fewer than 6 percent of doctors follow national sudden cardiac-death screening guidelines to their fullest extent when examining high school athletes, according to a Washington state survey released this week at the American Heart Association's scientific sessions.

Even more frightening: Not a single athletic director said that his or her school required doctors to comply with all state guidelines. Only 6 percent of athletic directors and less than half the doctors who responded to the survey indicated that they knew about the guidelines.

The survey was sent by mail and email to 2,190 pediatricians, family doctors, and athletic directors across the state over two months. A total of 1,113 pediatricians and family doctors and 317 high school athletic directors responded to the researchers.

The American Heart Association recommended a 12-step screening process back in 2007 to help prevent sudden cardiac arrest in youth athletes. When a student-athlete goes through cardiac arrest, his/her heart suddenly stops due to an irregular heart rhythm, which can be deadly within minutes if not immediately treated.

"A young person at the peak of physical prowess, dying without any warning—it's a shocking, tragic and potentially preventable death," said Dr. Nicolas Madsen, the study's lead researcher and a pediatric cardiology fellow at the University of Washington School of Medicine, in a statement.

According to statistics from the American Heart Association, one in every 30,000 to 50,000 high school student-athletes dies of sudden cardiac arrest on an annual basis.

Guidelines Ignored

The 2007 guidelines called for doctors to ask student-athletes eight medical questions (five about personal-health history, three about family-health history) and to go through a four-step physical examination of the students.

For instance, the doctors were advised to ask student-athletes about whether they felt chest pain/discomfort upon exercising, unexplained fainting, or had one or more relatives who died from heart disease.

The only problem: A sizable percentage of doctors aren't following the recommendations.

According to the survey's findings, 28 percent of doctors didn't always ask about chest pain during exercise, 22 percent didn't ask about unexplained fainting, and 26 percent didn't always ask about a family history of early heart-related death.

"We need new directions to educate providers and improve policy requirements so patients can actually benefit from these national recommendations," Madsen said.

Earlier this year, the National Athletic Trainers' Association released a statement encouraging states to pass youth-athlete safety laws in spite of budgetary concerns, and specifically highlighted sudden cardiac arrest as an area that needed immediate attention.

"It is disappointing that so much legislation has been introduced, yet so little has been passed," said NATA President Marjorie J. Albohm, a certified athletic trainer. "What makes this even more concerning is that state budgets are in crisis, so legislators are cutting programs that keep kids safe. ... And, we know that many of the current bills are specific to concussion and that there are other health conditions including sudden cardiac arrest and heat illness that require legislative attention."

One only needs to think back to the story of Wes Leonard, the 16-year-old basketball player who died this year of sudden cardiac arrest after hitting a game-winning shot, to realize why sudden cardiac arrest may be one of the next major youth-athlete safety frontiers.

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