Advisory Concerning Cardiac Screening for High School Athletes

May 29th, 2019

An Advisory from the Texas Chapter of the American College of Cardiology (ACC)

Dear District Superintendent, Principal, and Athletic Director,

This legislative session, the Texas Legislature passed a bill which encourages all schools within the UIL to make parents and students aware of the option to obtain an electrocardiogram (ECG) as part of their pre-participation evaluation (PPE) prior to involvement in high school sports.  As the organization responsible for ensuring the cardiovascular health of all people in Texas, we would like to clarify a few key points for you:

  • This bill does NOT mandate ECG screenings. Indeed, it does not change the current UIL practice of making all parents aware of the very rare but life threatening problem called sudden cardiac arrest (SCA) through a SCA Awareness Form.  This form educates parents, informs them of the current medical thinking, and instructs especially concerned parents to discuss obtaining an ECG on their children through their personal physician.  In keeping with this practice, the new bill encourages schools to direct parents to their medical homes, where such personalized decisions can be made on an individual basis.  If you are approached by advocate organizations, or for-profit groups offering to provide ECG screenings for your students, please be aware that such screenings are NOT required by this new law.
  • The TX Chapter of the ACC, and virtually every major medical organization in the United States, including the American Heart Association and the parent American College of Cardiology opposed this bill. This carefully considered opposition is based on the fact that there is no evidence that ECG screening saves the lives of young athletes (the vast majority of young athletes who suffer SCA have normal screenings).  Moreover, there exists the real possibility of harm (both physical and financial) from additional testing and procedures required to follow up on any abnormal findings;  in the overwhelming majority of healthy young people without symptoms or a family history of premature (earlier than age 50) sudden death,  any such abnormality will likely be “false positive”.  Indeed, a Scientific Statement issued by these national organizations strongly opposed broad based screening of large numbers of healthy young people with ECGs.  
  • In order to improve the quality of the current standard of care of young athletes who continue to be required to obtain a history and physical prior to participation in sports, the TX ACC chapter sponsored research by renowned sports cardiologists in TX and the US who are actively researching the best ways to screen young athletes.  This effort resulted in what is being called a “video enhanced” PPE or vPPE, which is now available in English and Spanish on the UIL website (https://www.uiltexas.org/health/cardiac-symptom-videos) , and which helps students and parents understand the key symptoms of which they should be aware.
  • The single most important strategy that will save the lives of ALL young people who suffer a SCA (not just athletes) is to ensure that an Automatic External Defibrillator (AED) is available in every school, along with a clear emergency action plan.  Equally as important is the need for every student and teacher to be certified in CPR (this is a very important life skill) and for there to be regular practice of this plan so that everyone knows where the AED is, and how to use it.  THERE IS UNIFORM AGREEMENT AMONG ALL MEDICAL PROFESSIONALS THAT THIS APPROACH IS THE BEST STRATEGY TO SAVE LIVES, AND WILL BE EFFECTIVE EVEN IF A STUDENT WHO IS NOT SCREENED OR HAS NORMAL SCREENING SUFFERS A SCA.

 If you have any questions about these key points, please do not hesitate to contact us at the TX Chapter of the ACC.  If we cannot answer your questions, we will be happy to link you with our renowned sports cardiologists around the state, and identify cardiologists in your own area who can assist you.  

Sincerely,

Ken Shaffer, MD

President, Texas Chapter of the American College of Cardiology

For further information or questions, email:
tcaccsportsecg@gmail.com