title: Results of a nationally implemented de novo cardiac screening programme in elite rugby players in England.
abstract: OBJECTIVE
  Screening of young competitive athletes remains a contentious issue. In 2010, a nationwide cardiac screening for all elite rugby players was introduced in England. This provided a unique opportunity to prospectively assess the feasibility and cost-effectiveness of a de novo, ECG-based cardiac screening programme.
  
  
  METHODS
  Between 2010 and 2012, 1191 rugby players aged ≥14 years underwent cardiac screening with a health questionnaire, 12-lead ECG and a consultation with a cardiologist. The players with concerning findings on initial evaluation were offered on-site transthoracic echocardiogram (TTE). Athletes were referred for further investigations as deemed necessary. The overall cost of the screening programme was estimated.
  
  
  RESULTS
  After initial evaluation, 9.7% of athletes underwent on-site TTE; 8.2% underwent on-site TTE due to ECG anomalies and 1.4% underwent on-site TTE due to concerns on the questionnaire. After TTE, only 2.9% of the total cohort was referred for further evaluation. Two players were diagnosed with potentially serious conditions; one with Wolff-Parkinson-White, who resumed competition after catheter ablation, and one with hypertrophic cardiomyopathy, who withdrew from competition. During a mean follow-up of 52.8±5.5 months, none of the players who were reassured experienced any adverse cardiac events. The total cost of the screening programme was £59 875, which averaged to a cost of £50 per player or £29 938 per condition identified. Application of refined ECG criteria would reduce the ECG false-positive rate to 4.9%.
  
  
  CONCLUSIONS
  Preparticipation cardiac screening with 12-lead ECG is feasible. Refinement of the ECG criteria, the use of on-site TTE and expert setting can minimise the burden of unnecessary investigations and reduce costs.
authors.affiliation: Cardiovascular Sciences Research Centre, Cardiovascular and Cell Sciences Research Institute, St George's University of London, London, UK.
authors.forename: Saqib
authors.initials: S
authors.lastname: Ghani
authors.affiliation: Cardiovascular Sciences Research Centre, Cardiovascular and Cell Sciences Research Institute, St George's University of London, London, UK.
authors.forename: Michael
authors.initials: M
authors.lastname: Papadakis
authors.affiliation: Rugby Football Union, Middlesex, UK.
authors.forename: Simon
authors.initials: S
authors.lastname: Kemp
authors.affiliation: Cardiovascular Sciences Research Centre, Cardiovascular and Cell Sciences Research Institute, St George's University of London, London, UK.
authors.forename: Abbas
authors.initials: A
authors.lastname: Zaidi
authors.affiliation: Cardiovascular Sciences Research Centre, Cardiovascular and Cell Sciences Research Institute, St George's University of London, London, UK.
authors.forename: Nabeel
authors.initials: N
authors.lastname: Sheikh
authors.affiliation: Cardiovascular Sciences Research Centre, Cardiovascular and Cell Sciences Research Institute, St George's University of London, London, UK.
authors.forename: Sabiha
authors.initials: S
authors.lastname: Gati
authors.affiliation: Cardiovascular Sciences Research Centre, Cardiovascular and Cell Sciences Research Institute, St George's University of London, London, UK.
authors.forename: Hariharan
authors.initials: H
authors.lastname: Raju
authors.affiliation: Mid Yorkshire Hospital NHS Trust, Wakefield, UK.|RWC England 2015 Medical Advisory Group.|Premiership Rugby, Twickenham, UK.
authors.forename: Andy
authors.initials: A
authors.lastname: Smith
authors.affiliation: Premiership Rugby, Twickenham, UK.
authors.forename: Corin
authors.initials: C
authors.lastname: Palmer
authors.affiliation: Countess of Chester NHS Hospital Trust, UK.|Liverpool Heart and Chest NHS Hospital Trust, Liverpool, UK.
authors.forename: John
authors.initials: J
authors.lastname: Somauroo
authors.affiliation: Cardiovascular Sciences Research Centre, Cardiovascular and Cell Sciences Research Institute, St George's University of London, London, UK.
authors.forename: Sanjay
authors.initials: S
authors.lastname: Sharma
keywords: Athlete's heart; Cardiovascular; Rugby