Limitations of Current AHA Guidelines and Proposal of New Guidelines for the Preparticipation Examination of Athletes.
OBJECTIVE
To examine the prevalence of athletes who screen positive with the preparticipation examination guidelines from the American Heart Association, the AHA 12-elements, in combination with 3 screening electrocardiogram (ECG) criteria.


METHODS
Observational cross-sectional study.


METHODS
Stanford University Sports Medicine Clinic.


METHODS
Total of 1596 participants, including 297 (167 male; mean age, 16.2 years) high school athletes, 1016 (541 male; mean age, 18.8 years) collegiate athletes, and 283 (mean age, 26.3 years) male professional athletes.


METHODS
Athletes were screened using the 8 personal and family history questions from the AHA 12-elements. Electrocardiograms were obtained for all participants and interpreted using Seattle criteria, Stanford criteria, and European Society of Cardiology (ESC) recommendations.


RESULTS
Approximately one-quarter of all athletes (23.8%) had at least 1 positive response to the AHA personal and family history elements. High school and college athletes had similar rates of having at least 1 positive response (25.9% vs 27.4%), whereas professional athletes had a significantly lower rate of having at least 1 positive response (8.8%, P < 0.05). Females reported more episodes of unexplained syncope (11.4% vs 7.5%, P = 0.017) and excessive exertional dyspnea with exercise (11.1% vs 6.1%, P = 0.001) than males. High school athletes had more positive responses to the family history elements when compared with college athletes (P < 0.05). The percentage of athletes who had an abnormal ECG varied between Seattle criteria (6.0%), Stanford criteria (8.8%), and ESC recommendations (26.8%).


CONCLUSIONS
Many athletes screen positive under current screening recommendations, and ECG results vary widely by interpretation criteria.


CONCLUSIONS
In a patient population without any adverse cardiovascular events, the currently recommended AHA 12-elements have an unacceptably high rate of false positives. Newer screening guidelines are needed, with fewer false positives and evidence-based updates.
*Division of Cardiovascular Medicine, Standford University, Palo Alto, California; and †Division of Cardiovascular Medicine, Veterans Affairs Palo Alto Medical Center, Palo Alto, California.
Tim P
TP
Dunn
David
D
Pickham
Sonya
S
Aggarwal
Divya
D
Saini
Nikhil
N
Kumar
Matthew T
MT
Wheeler
Marco
M
Perez
Euan
E
Ashley
Victor F
VF
Froelicher
D000293:Adolescent; D000328:Adult; D000573:American Hospital Association; D056352:Athletes; D003430:Cross-Sectional Studies; D016757:Death, Sudden, Cardiac / Q000517:prevention & control; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D010808:Physical Examination; D017410:Practice Guidelines as Topic; D014481:United States; D055815:Young Adult