Medical experts at odds over value of cardiac testing for kids

EKG Technician Casey Yanson hooks up leads to Connor Shimberg as they demonstrate how an electrocardiogram can be done easily on high school students.

SKIP O’ROURKE | Times

EKG Technician Casey Yanson hooks up leads to Connor Shimberg as they demonstrate how an electrocardiogram can be done easily on high school students.

TAMPA — The pitch for free cardiac tests that launched last week in Hillsborough schools sounded like a no-brainer: Lives could be saved by screening seemingly healthy children for heart defects that can lead to sudden death.

But parents aren't being told that medical experts are hotly divided over the value of such widespread use of electrocardiogram (EKG) screenings.

While All Children's Hospital in St. Petersburg is a partner in the ambitious effort — believed to be the largest ever nationally — a prominent group of pediatric cardiologists think it's deeply flawed.

The debate here echoes a national controversy over how to protect children and young athletes from an incredibly rare yet unspeakably tragic death. And whether they know it or not, Hillsborough students are poised to become research subjects in attempts to resolve this dispute.

Cost, logistics and the potential for false-positive readings are among the reasons leading groups such as the American Heart Association do not recommend mandatory EKG screenings, though it does not oppose voluntary testing.

"Jumping on the bandwagon of EKGs for everybody — right now is a little too early," said Dr. Stuart Berger, medical director of the Herma Heart Center at Children's Hospital of Wisconsin and a member of an American Heart Association panel that reviewed the issue. "The answer to these (logistical issues) have to be worked out, so we're not doing more harm than good."

• • •

Years ago, Dr. Jorge McCormack participated in free cardiac screenings with St. Joseph's Hospital in Tampa. A cardiologist specializing in the abnormal heart rhythms that can lead to sudden death in children, he went to local schools and offered EKG testing to students.

Those nights, McCormack couldn't sleep. "I went home thinking to myself, 'I missed something. I told one of those kids that they were fine, and they were not fine.' "

In almost 20 years at Pediatric Cardiology Associates, a medical practice specializing in children's heart conditions, McCormack says he has seen many children who have life-threatening heart conditions but look perfectly normal on EKGs.

EKGs are very good at detecting hypertrophic cardiomyopathy, a condition characterized by thickening of the heart muscle that is the leading cause of sudden death in the young. But the condition can develop at any time from childhood into adulthood, McCormack said, so a clear EKG screening doesn't mean a child is cleared for life.

EKGs won't detect anomalies of the coronary arteries, the second-leading cause of death in young athletes. They only sometimes pick up on rhythm disorders.

McCormack, who sees patients at All Children's and other local hospitals, no longer participates in mass screenings. Instead, he visits major hospitals and doctors offices to educate pediatricians and family physicians on the signs of a potential cardiac problem.

Those clues include passing out, seizures, a family history of cardiac abnormalities, an unexplained death in a young relative, and even a sudden infant death in the family. When a problem is suspected, the child should be referred for a full evaluation, which includes an EKG, along with more sensitive tests.

"It's rare to have death as your first sign," said McCormack, noting that the Tampa Bay area has not seen a sudden death in a child in several years. "Do we have a screening program? Yes, it's called education. And it's working."

• • •

While an EKG is not a perfect test, Dr. Gul Dadlani, the medical director of pediatric cardiology at All Children's, says no one would argue it isn't worthwhile. And cost, a major concern in the debate over mass screenings, isn't a factor with the privately funded Hillsborough program.

Known as SafeBeat, the project is testing out a model that should help resolve the debate over whether the United States can screen on the scale of Italy, where athletes are routinely screened using EKGs. European cardiologists and the International Olympic Committee recommend such testing, but that does not easily translate here because of differences in population and health care systems.

Funding for Hillsborough's program, which is voluntary, is coming from David and Jayne Vining of Massachusetts, who founded the nonprofit Cardiac Arrhythmia Syndromes Foundation in honor of her son, Marc, who died of a heart defect.

In a private doctor's office, the test could cost $100 to $150, organizers estimate. The Vinings said their seven-school screening effort this spring could cost about $250,000. They plan to visit all Hillsborough high schools over three years and seek business partners to expand.

Pediatric cardiologists at All Children's will read the tests. The results will be shared with families, who can seek follow-up through their health care providers or at All Children's. The hospital will treat children without insurance.

"We really hope that this can answer the question for us: Is this screening modality saving lives and cost-effective in terms of a model for a national screening project?" said Dadlani, who was in practice with McCormack's group before joining the All Children's service.

Dadlani noted that in the first screenings last week at Plant High School in Tampa, EKGs identified a child with a significant cardiac arrhythmia that might have gone undetected.

• • •

Questions about cost have dominated the U.S. debate, but many experts are just as concerned about a healthy child having an abnormal EKG, which would require an anxious period of testing to rule out a problem.

Data suggests that such false positives could affect anywhere from 3 to 15 percent of the population screened, said Berger, the Wisconsin pediatric cardiologist.

And athletes are particularly prone to false-positive results.

"You could misread the EKG and not allow that kid to play — and he would never have had a problem," said Dr. Sharon Dabrow, a general pediatrician and professor at the University of South Florida. "Even a true positive would cause a lot of anxiety and concern, because just because you have an abnormal EKG doesn't mean you are going to have sudden death."

Dabrow would not recommend EKG screening for children simply because it's free through their school, though she would give parents the choice.

That's also the view of Dr. Karalee Kulek-Luzey, a pediatrician and the medical director of the Pediatric Health Care Alliance. "I would say, 'I don't think you need it, but if you feel like you want to do this because it's a free service to your child, you can do it.' "

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

Medical experts at odds over value of cardiac testing for kids 04/03/10 [Last modified: Saturday, April 3, 2010 8:48pm]

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