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Harms and benefits of screening young people to prevent sudden cardiac death

BMJ 2016; 353 doi: (Published 20 April 2016) Cite this as: BMJ 2016;353:i1156
  1. Hans Van Brabandt, researcher,
  2. Anja Desomer, researcher,
  3. Sophie Gerkens, economist,
  4. Mattias Neyt, health economist
  1. 1Belgian Health Care Knowledge Centre (KCE), Brussels, Belgium
  1. Correspondence to: H Van Brabandt hans.vanbrabandt{at}
  • Accepted 15 February 2016

Sudden cardiac death of young athletes needs to be avoided but does screening really help? Hans Van Brabandt and colleagues look at the evidence

Sudden cardiac death of a young person on a sports field is a devastating event. Often these deaths are due to an unrecognised underlying heart condition, and screening has been proposed as a method to prevent them. However, disagreement remains about its benefits and harms.

In Italy, screening before participation in competitive sport has been mandatory since the 1970s. But the Netherlands abandoned its mandatory programme in 1984 because of the poor diagnostic performance of screening tests.1 In the UK, Cardiac Risk in the Young (CRY), a charity offering support and counselling to affected families, runs screening events, but the National Screening Committee decided last year not to recommend a population screening programme.2 Here, we summarise the findings of our literature review on the benefits and harms of pre-participation screening for non-professional athletes aged 14-34 years.3 We defined athletes as anyone participating in an organised team or individual sport that involves regular competition against others, places a high premium on excellence and achievement, and requires some form of systematic training.4

How common is sudden cardiac death in young healthy athletes?

Sudden cardiac death may be caused by a panoply of rare genetic and acquired heart disorders, present in 0.3% of the population.5 Most affected people are not aware of the disease and lead a normal life, but some develop symptoms such as dizziness, fainting, or breathlessness, which leads to a diagnosis. In around 1% of young athletes with unrecognised heart disease, sudden death will be the first and only manifestation of the disease,6 7 8 and it is these people that screening aims to detect. Although it is uncertain whether sudden cardiac death occurs more often during exercise than at …

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