title: Cost Implications of Using Different ECG Criteria for Screening Young Athletes in the United Kingdom.
abstract: High false-positive rates and cost of additional investigations are an obstacle to electrocardiographic (ECG) screening of young athletes for cardiac disease. However, ECG screening costs have never been systematically assessed in a large cohort of athletes.
  
  
  
  This study investigated the costs of ECG screening in athletes according to the 2010 European Society of Cardiology (ESC) recommendations and the Seattle and refined interpretation criteria.
  
  
  
  Between 2011 and 2014, 4,925 previously unscreened athletes aged 14 to 35 years were prospectively evaluated with history, physical examination, and ECG (interpreted with the 2010 ESC recommendations). Athletes with abnormal results underwent secondary investigations, the costs of which were based on U.K. National Health Service Tariffs. The impact on cost after applying the Seattle and refined criteria was evaluated retrospectively.
  
  
  
  Overall, 1,072 (21.8%) athletes had an abnormal ECG on the basis of 2010 ESC recommendations; 11.2% required echocardiography, 1.7% exercise stress test, 1.2% Holter, 1.2% cardiac magnetic resonance imaging, and 0.4% other tests. The Seattle and refined criteria reduced the number of positive ECGs to 6.0% and 4.3%, respectively. Fifteen (0.3%) athletes were diagnosed with potentially serious cardiac disease using all 3 criteria. The overall cost of de novo screening using 2010 ESC recommendations was $539,888 ($110 per athlete and $35,993 per serious diagnosis). The Seattle and refined criteria reduced the cost to $92 and $87 per athlete screened and $30,251 and $28,510 per serious diagnosis, respectively.
  
  
  
  Contemporary ECG interpretation criteria decrease costs for de novo screening of athletes, which may be cost permissive for some sporting organizations.
authors: Division of Cardiovascular Sciences, St. George's University of London, London, United Kingdom.
authors: Harshil
authors: H
authors: Dhutia
authors: Division of Cardiovascular Sciences, St. George's University of London, London, United Kingdom.
authors: Aneil
authors: A
authors: Malhotra
authors: Division of Cardiovascular Sciences, St. George's University of London, London, United Kingdom.
authors: Vincent
authors: V
authors: Gabus
authors: Division of Cardiovascular Sciences, St. George's University of London, London, United Kingdom.
authors: Ahmed
authors: A
authors: Merghani
authors: Division of Cardiovascular Sciences, St. George's University of London, London, United Kingdom.
authors: Gherardo
authors: G
authors: Finocchiaro
authors: Division of Cardiovascular Sciences, St. George's University of London, London, United Kingdom.
authors: Lynne
authors: L
authors: Millar
authors: Division of Cardiovascular Sciences, St. George's University of London, London, United Kingdom.
authors: Rajay
authors: R
authors: Narain
authors: Division of Cardiovascular Sciences, St. George's University of London, London, United Kingdom.
authors: Michael
authors: M
authors: Papadakis
authors: LSE Health, Department of Social Policy, London School of Economics and Political Science, London, United Kingdom.
authors: Huseyin
authors: H
authors: Naci
authors: Division of Cardiovascular Sciences, St. George's University of London, London, United Kingdom.
authors: Maite
authors: M
authors: Tome
authors: LSE Health, Department of Social Policy, London School of Economics and Political Science, London, United Kingdom. Electronic address: sasharma@sgul.ac.uk.
authors: Sanjay
authors: S
authors: Sharma
mesh_terms: D000293:Adolescent; D000328:Adult; D056352:Athletes; D003365:Costs and Cost Analysis; D016757:Death, Sudden, Cardiac / Q000453:epidemiology / Q000517:prevention & control*; D004562:Electrocardiography / Q000191:economics* / Q000379:methods; D005260:Female; D006331:Heart Diseases / Q000175:diagnosis* / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008297:Male; D008403:Mass Screening / Q000191:economics*; D012189:Retrospective Studies; D013178:Sports Medicine / Q000379:methods*; D006113:United Kingdom / Q000453:epidemiology; D055815:Young Adult
keywords: athlete; electrocardiogram; pre-participation screening; sudden cardiac death