PACES Survey ECG Screening November 2008 AHA Stuart Berger Robert Campbell Jonathan Drezner

The Survey Web-based survey Posted for two weeks to all PACES members Survey closed Data compiled for presentation A spring-board for future discussions n = 88

Do you agree with the 2007 American Heart Association pre- participation screening guidelines, which does not advocate for routine ECG screening as part of the athletic pre- participation screening?

Do you personally believe routine ECG’s should be performed on all high school athletes? 54% 34% 12%

If yes, how many times should high school students be screened with an ECG?

Do you personally believe routine ECG’s should be performed on all college athletes? 47% 42% 11%

If yes, how many times should college students athletes be screened with an ECG?

Do you personally believe routine ECG’s should be performed on all children in organized sports? 15% 76% 9%

Do you personally believe routine ECG’s should be performed on all ADD/ADHD patients? 13% 83% 4%

Do you personally believe routine ECG’s should be performed on all of our youth? 8% 80%

Personal beliefs of routine ECGs by PACES members with regard to ECG screening in

Do you personally participate in an ECG screening activity now? Yes n = 30 30% 70%

Do physicians in your practice use a standard consistent published table of ECG normal values for interpretation of ECG’s in young athletes? 60% 40%

What do you believe is the false-positive rate of ECG screening in young athletes (age 14-22)?

If the false-positive rate was 5% using pre- established ECG criteria to distinguish normal from abnormal, would you be in favor of ECG screening during the athletic pre-participation evaluation? PLEASE BE SURE THAT YOU UNDERSTAND THE FOLLOWING IN ANSWERING THIS QUESTION: A false positive rate of 5% with an incidence of SCD of 1 in 1000 means that there will be 50 false positives and 1 true positive per 1000 screened or a 2% positive predictive value.

If the false-positive rate was 5% using pre- established ECG criteria to distinguish normal from abnormal, would you be in favor of ECG screening during the athletic pre-participation evaluation? 65% 35%

If the false-positive rate was 2% using pre- established ECG criteria to distinguish normal from abnormal, would you be in favor of ECG screening during the athletic pre-participation evaluation ? PLEASE BE SURE THAT YOU UNDERSTAND THE FOLLOWING IN ANSWERING THIS QUESTION: A false positive rate of 2% with an incidence of SCD of 1 in 1000 means that there will be 20 false positives and 1 true positive per 1000 screened or a 5% positive predictive value.

If the false-positive rate was 2% using pre- established ECG criteria to distinguish normal from abnormal, would you be in favor of ECG screening during the athletic pre-participation evaluation? 61% 39%

Would you support a PACES initiative to evaluate the applicability of routine ECG screening for certain pediatric patient populations? Yes or No 91% 9%

Would you support a PACES initiative to evaluate the applicability of routine ECG screening for certain pediatric patient populations? Athletes 92% 8%

Would you support a PACES initiative to evaluate the applicability of routine ECG screening for certain pediatric patient populations? ADHD 58% 42%

Would you support a PACES initiative to evaluate the applicability of routine ECG screening for certain pediatric patient populations? All 54% 46%

Summary of Support for PACES Initiative(s) to Evaluate applicability of ECG screening

Do you/your group advocate use of a specific standardized athletic pre-participation history/pre- participation evaluation form? 61% 39%

Additional Comments SCD occurs in 1/1000 of what group: CHD, syncope, CP, HCM? What specific diseases are we screening for (each has a level of ECG precision); maybe specifically HCM, LQT, WPW You address the age of the 1 st ECG question pretty well, but not the derivative question of repeated ECGs in those who pass the initial screen What cutoff LQT would people be willing to use for an ECG based referral Might be worth asking what confidence people have in making a firm diagnosis/exclusion (both) of LQT with different QTc of 44, 45, 46, 47, 48

Summary/Next Steps? Athletes seem to be the most compelling group to discuss 30% do some sort of ECG screening now; exactly what type and how? 60% use published table of normal ECG criteria in evaluation of athletes Only 60% use a standard PPE form; can we make this 100%? Didn’t include neonates in the survey

Summary/Next Steps? False positives with ECG screening: we are only guessing; most of us believe 5-10% Corrado 8% Fuller 15% There seems to be an overwhelming interest in PACES taking the initiative to evaluate the applicability of ECG screening Athletes >>> All children > ADHD

Summary/Next Steps? False positives with ECG screening: we are only guessing; most of us believe 5-10% Corrado 8% Fuller 15% There seems to be an overwhelming interest in PACES taking the initiative to evaluate the applicability of ECG screening Athletes >>> All children > ADHD How might we go forward? A follow-up future symposium?