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Cardiac screening for Hillsborough teens could help solve a national debate

Technician Casey Yanson hooks up leads on Plant High student Connor Shimberg to show how easily an EKG can be performed. Young athletes suffer about 100 sudden deaths in the U.S. a year.

SKIP O’ROURKE | Times

Technician Casey Yanson hooks up leads on Plant High student Connor Shimberg to show how easily an EKG can be performed. Young athletes suffer about 100 sudden deaths in the U.S. a year.

TAMPA — Hillsborough County schools are entering the national debate over whether to screen seemingly healthy children for heart defects that can lead to sudden death.

Beginning next week, free electrocardiogram (EKG) screenings will be offered to thousands of high school students in Hills­borough, the national Cardiac Arrhythmia Syndromes Foundation announced on Monday. The group is working with All Children's Hospital in St. Petersburg.

Organizers believe this is the largest EKG screening effort in the United States to target such large numbers of children without a history of cardiac problems. They hope the results will help resolve whether widespread screening should be done nationally to help prevent the roughly 100 sudden deaths each year in young athletes. The data on non-athletes is even less clear.

"That's our hope: That we could add data to try to shed light on a national question," said Dr. Gul Dadlani, medical director of pediatric cardiology at All Children's. "We know (EKG screening) can save lives, but is it cost effective and beneficial in the U.S. in a pediatric population?"

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In the coming weeks, parents of children at seven Hillsborough high schools have the first crack at the voluntary program, which organizers hope to expand along Florida's west coast, selected due to All Children's interest.

Pinellas officials turned down the offer to screen during the school day, concerned it would be disruptive. Discussions continue in neighboring districts.

Conducted behind a privacy screen by a health professional, the painless EKG test involves placing 10 electrode stickers on the student's chest. (Parents would have to give their written permission and can register online at www.SafeBeat.org.)

Results are transmitted electronically to cardiologists at All Children's. SafeBeat, as the program is known, will notify parents of results. If needed, families can follow up with their pediatrician or with All Children's, which has pledged to provide care even if families cannot pay for it.

Screenings start next week on a first-come, first-served basis for 600 students at Plant High in South Tampa. Then the program moves on to six other Hills­borough high schools — Robinson, Steinbrenner, Middleton, Alonso, King and Leto.

In a private doctor's office, EKG screening could cost $100 to $150, organizers estimated. They said the seven-school effort will cost about $250,000.

Funding is from David and Jayne Vining, the Massachusetts residents who founded the nonprofit Cardiac Arrhythmia Syndromes Foundation in honor of her son, Marc, who died of a congenital heart defect. The couple has spent "well into the millions" on smaller initiatives around the country, according to David Vining. They are seeking business partners and sponsors to expand the program and plan to visit all of Hillsborough's high schools over three years.

Sudden cardiac deaths are rare in children, but the Vinings believe that's no excuse not to screen. "What is a child's life worth?" Jayne Vining asked at a news conference for the Hillsborough launch. "Just ask a parent who has lost a child," she said.

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But the medical case for EKG screening in children and teens is more complicated than the emotional appeal. People ages 15 to 24 are most likely to die from accidents, homicides and suicides, national statistics show. Cardiac deaths are far fewer, and data aren't clear.

With incidence reports ranging widely, the American Heart Association estimates there may be about 5,760 cardiac arrests annually in children that happen outside of hospitals, from all causes including trauma and sudden infant death syndrome.

Leading medical groups are divided over the value of EKG screening for young athletes, the subject of new research published this month in the Annals of Internal Medicine.

A study of about 500 Harvard athletes found that EKGs identified 10 of 11 of them who were known to have heart conditions. But it flagged a much larger number of athletes who later were found to be fine but would have been subjected to more testing, anxiety and maybe exclusion from sports.

Ultimately, just three of the Harvard athletes were found to have heart conditions that warranted sports restrictions.

Physicians at the University of South Florida have had similar experiences with screening their athletes over the past two years, said Dr. Anne Curtis, USF's chief of cardiovascular disease. Perhaps one in 10 EKGs may pick up on something not perfectly normal. She could think of just one athlete who was told not to participate in sports.

"Probably the biggest debate about doing widespread screening is cost effectiveness," she said. "Does it make sense to screen many, many children to pick up a very rare occasional problem?"

Adding EKGs to standard physicals for young athletes would cost an additional $42,900 per year of life saved, another report in the Annals of Internal Medicine found. The estimate is based on data from Italy, which routinely screens competitive athletes.

The screening test isn't guaranteed to pick up everything that could lead to a sudden cardiac death. EKG testing can identify almost all cases of hypertrophic cardiomyopathy, a condition that is typically genetic and characterized by excessive thickening of the heart.

Inherited irregular heart beats, another potentially fatal problem, can also be detected through EKG screening but not always. And the test is not as valuable for detecting problems like abnormal coronary arteries or heart defects caused by viral infections that can occur anytime.

Parents considering screening may want to look at family history and whether their child has had unexplained dizziness or fainting spells as well as cardiac symptoms with exercise.

Letitia Stein can be reached at lstein@sptimes.com or (813) 226-3322. For more health news, visit tampabay.com/health.

Cardiac screening for Hillsborough teens could help solve a national debate 03/22/10 [Last modified: Tuesday, March 23, 2010 11:18am]

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