AHA: Vital Elements Often Missing from Sports Physicals
By Todd Neale, Senior Staff Writer,
November 15, 2011
Action Points
Note that this study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.
Explain that a survey of physicians and athletic directors found that few providers or schools were compliant with AHA guidelines for screening young athletes by history and physical for risk of sudden cardiac death.
Note that the main reason given for lack of compliance was lack of awareness of the guidelines.
Review
ORLANDO -- Compliance with American Heart Association guidelines for pre-participation screening for cardiovascular abnormalities in young athletes is poor, a survey of physicians and athletic directors in Washington state showed.
Only about 6% of physicians were in complete compliance with the guidelines, and 13% performed two-thirds or fewer of the 12 items recommended to be part of the evaluation, according to Nicolas Madsen, MD, MPH, a pediatric cardiology fellow at Seattle Children's Hospital.
The low percentage of physicians who adhered to the guidelines was driven by a lack of knowledge of the guidance -- only 49% of pediatricians and 45% of family physicians knew about them, Madsen reported at the AHA meeting here.
The way forward would seem to be the development of a single, statewide pre-participation physical evaluation form that is well supported, he said.
In an interview, Christine Lawless, MD, co-chair of the American College of Cardiology's Sports and Exercise Cardiology Council, said that the problem of physicians not following guidelines is a national problem.
That's particularly true when the guidance is based largely on expert consensus, as is the case with the pre-participation screening guidelines, said Lawless, who practices with Sports Cardiology Consultants in Chicago.
A lack of awareness of the guidelines, or of the importance of specific recommendations within the documents, also may contribute to suboptimal adherence, she said.
She said the best way to overcome those issues is through a multipronged educational approach targeted to healthcare professionals who perform pre-participation physicals; coaches and athletic directors; parents; and the children and teens themselves.
The pre-participation physical evaluation is done to screen for risk of sudden cardiac death, which is the leading cause of mortality among young athletes, Marsden said. The estimated national cost of the screening is $250 million per year.
The AHA issued its guidelines for conducting the pre-participation physical in 1996 and reaffirmed them in 2007. The guidance includes a list of 12 items covering medical history, family history, and a physical examination that should be completed.
The researchers surveyed physicians and athletic directors in Washington to assess compliance with the guidelines. The participants included 559 members of the American Academy of Pediatrics, 554 members of the Washington Academy of Family Physicians, and 317 athletic directors.
Only about half of the physicians, and just 6% of the athletic directors, knew about the AHA guidelines.
Most of the physicians always asked the athletes they were screening about the five items of the medical history:
Chest pain
Syncope
Dyspnea/fatigue
Prior heart murmur
Elevated blood pressure
However, 6% to 18% of the respondents asked about them half of the time or less.
For family history, three-quarters of physicians always asked whether the athletes had a relative who had died before age 50, but only 43% asked about relatives with disabilities from heart disease before age 50, and 33% asked about a relative with known heart disease.
During the physical examination, the physicians performed well for always checking for heart murmur (95%) and brachial blood pressure (87%), but only half always checked for Marfan stigmata and only 29% checked femoral pulses.
Compliance with the guidelines improved among physicians who performed a greater number of physicals; made more cardiology referrals and had a higher comfort level about knowing when to refer; and who were satisfied with the physical evaluation (P<0.05 for all).
However, compliance did not differ based on provider type, years of experience, location, or exposure to sudden cardiac death.
The survey of athletic directors revealed that 0% of schools were in complete compliance with the AHA guidelines, and 60% used a form that included only eight of the 12 recommended elements of the pre-participation evaluation.
Most of the respondents favored adoption of a single statewide pre-participation physical evaluation form, with support strongest among the physicians.
Lawless said a standardized form within each state would help improve compliance with the guidelines.