Cardiovascular evaluation of middle-aged individuals engaged in high-intensity sport activities: implications for workload, yield and economic costs.
BACKGROUND
The European Association of Cardiovascular Prevention and Rehabilitation (EACPR) recommends cardiovascular evaluation of middle-aged individuals engaged in sport activities. However, very few data exist concerning the impact of such position stand. We assessed the implications on workload, yield and economic costs of this preventive strategy.


METHODS
Individuals aged 35-65 years engaged in high-intensity sports were examined following the EACPR protocol. Athletes with abnormal findings or considered at high-cardiovascular risk underwent additional examinations. The costs of the overall evaluation until diagnosis were calculated according to Swiss medical rates.


RESULTS
785 athletes (73% males, 46.8±7.3 years) were enrolled over a 13-month period. Among them, 14.3% required additional examinations: 5.1% because of abnormal ECG, 4.7% due to physical examination, 4.1% because of high-cardiovascular risk and 1.6% due to medical history. A new cardiovascular abnormality was established in 2.8% of athletes, severe hypercholesterolaemia in 1% and type 2 diabetes in 0.1%. Three (0.4%) athletes were considered ineligible for high-intensity sports, all of them discovered through an abnormal ECG. No athlete was diagnosed with significant coronary artery disease on the basis of a high-risk profile or an exercise ECG. The cost was US$199 per athlete and US$5052 per new finding.


CONCLUSIONS
Cardiovascular evaluation of middle-aged athletes detected a new cardiovascular abnormality in about 3% of participants and a high-cardiovascular risk profile in about 4%. Some of these warranted exclusion of the athlete from high-intensity sport. The overall evaluation seems to be feasible at reasonable costs.
Division of Cardiology, Ospedale San Giovanni Bellinzona, Switzerland.
Andrea
A
Menafoglio
Division of Cardiology, Ospedale San Giovanni Bellinzona, Switzerland.
Marcello
M
Di Valentino
Division of Cardiology, Ospedale San Giovanni Bellinzona, Switzerland.
Alessandra Pia
AP
Porretta
Division of Cardiology, Ospedale San Giovanni Bellinzona, Switzerland.
Pietro
P
Foglia
Division of Cardiology, Ospedale San Giovanni Bellinzona, Switzerland.
Jeanne-Marie
JM
Segatto
Center for Sports Medicine, Ospedale La Carità Locarno, Switzerland.
Patrick
P
Siragusa
Center for Sports Medicine, Ospedale La Carità Locarno, Switzerland.
Reto
R
Pezzoli
Center for Sports Medicine, Ospedale La Carità Locarno, Switzerland.
Mattia
M
Maggi
Center for Sports Medicine, Ospedale La Carità Locarno, Switzerland.
Gian Antonio
GA
Romano
Division of Cardiology, Ospedale Civico Lugano, Switzerland.
Giorgio
G
Moschovitis
Division of Cardiology, Ospedale San Giovanni Bellinzona, Switzerland.
Augusto
A
Gallino
D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000517:prevention & control*; D003365:Costs and Cost Analysis; D004562:Electrocardiography / Q000191:economics / Q000706:statistics & numerical data; D005080:Exercise Test; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010808:Physical Examination / Q000191:economics / Q000706:statistics & numerical data; D011446:Prospective Studies; D013177:Sports / Q000191:economics / Q000502:physiology*; D013178:Sports Medicine / Q000191:economics / Q000379:methods*; D016526:Workload / Q000191:economics / Q000706:statistics & numerical data
Cardiology; Cardiology prevention