Screening against sudden cardiac death in young non-professional athletes: the KCE and insurance companies.
The Health Technology Assessment on cardiovascular pre-participation screening in young athletes, produced by the Belgian Health Care Knowledge Centre (KCE) warrants comment.(1)
First, KCE, once more, must be commended for its assessments: simple, comprehensive, well-evidence based and, avoiding conflict of interest. Clearly, the small kingdom of Belgium outperforms France.(2) Moreover, KCE is a beacon with a true concern for shared decision making: Eg. for breast cancer screening it provides leaflets with clear pictographs (absolute numbers with a consistent denominator (/1000 screened) and time frames employing the same scale for information on gains and losses of the options).(3) I am not aware of such information leaflets from another national agency in Europe.
Second, the long lasting Italian embargo on data about sport-related mortality is not only shocking but also depressing.(4) Sadly, science integrity, even when financial industrial interests are not present, is not the motto yet.
Third, all these important efforts (1,4,5) may remain useless: a) recommendations from professional associations such as the French one stating “ … and a 12-lead resting ECG from 12 years at the issuing of the first license, renewed every three years, then every 5 years from 20 years to 35 years” may not be updated soon;(6) b) insurance companies will continue to dictate the rule, unless forbidden to request medical certificates.
1 Van Brabandt H, Desomer A, Gerkens S, Neyt M. Preparticipation screening for the prevention of sudden cardiac death in young non-professional athletes: harms outweigh benefits. BMJ 2016;352:i1156.
2 Prescrire.[Clinical practice guidelines from the National Health Authority: too many hidden conflicts of interest.] Rev Prescrire 2009; 29 (309):546.
3 Belgian Health Care Knowledge Center. Report 216. [Breast cancer screening: messages for an informed choice]. 2014. Available at http://kce.fgov.be/fr/publication/report/d%C3%A9pistage-du-cancer-du-sei.... Accessed 9 May 2016.
4 Cohen D. Data on benefits of screening for sudden cardiac death are withheld. BMJ 2016 20;353:i2208.
5 Semsarian C, Ingles J. Preventing sudden cardiac death in athletes. BMJ 2016 20;353:i1270.
6 Brion R, Carré F. [Recommendations on cardiovascular check for practicing sports in competition among the 12 and 35 y old]. Société Française de cardiologie. After 2007. Available at http://www.sfcardio.fr/sites/default/files/pdf/edito_ECG.pdf. Accessed 9 May 2016.
Competing interests: No competing interests