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The high profile nature of this debate following recent events in the UK means the media and politicians will also play a role in what happens with asymptomatic screening in the NHS as well as the medics. So it really is imperative that we have a balanced discussion about the pros and cons.

Two areas that are rarely discussed are the negative impact of screening and informed consent.

Looking at the well documented pie chart of repsonsible pathology for SACD- we know that only around 60-80% of pathology may be picked up by one off screening. The recent high profile cases in the UK are not good anecdotal evidence for repeated screening, although you wouldnt realise it by the pro-screening media comments subsequently. But certainly screening will miss some of the congential conditions and of course the acquired causes such as post myocarditis.

Of the commonest conditions – hypertrophic cardiomyopathy for example, this is said to be present in around 1 in 500 of the population, but with an annual risk of death of between 0.6-1% per year. Statistically this means its very common but a lot of people will live a long time or near normal life expectancy without knowing it. Obviously there will be a number identified as “high risk” through risk stratification by experienced Cardiologists – but with an overall risk of 1% per year – this will only be a very small number.

So what happens to the number that we identify as at risk? (they are of course true positives – even with a low risk of dying).

Rates of depression and anxiety disorders in young adults following a myocardial infarction are well documented in the literature. My own small observational study that was presented at UKSEM in 2011 suggested that the risk of being turned down for a life insurance product if you failed a population screening test for SACD was up to 50% – 50 times higher than your annual risk of dying.

So whilst there has been a lot of fantastic progress in the science behind ECG screening, risk stratificiation and epidemiology in recent years, it is important the debate remembers the negative impact on many as we try to idenfity the individuals who we can truely save through a population screening programme.

Given the high media profile of this subject, especially in the UK national sport of football,  providing true informed consent is going to be difficult going forward. I note the blog refers to sports organisations and their own policy and screening. But focussed screening on small discrete populations of athletes is a different model to widespread population screening. Even in governing body screening there are challenges of informed consent. It would be difficult for an aspiring athlete to make an informed choice if he were told he could never be a professional sportsman if he didnt have this ECG, or if he could not participate in this junior world cup etc. Yet many of these individuals will not go on to be career elite athletes so may be effected by the occupational, financial or insurance restrictions that going through SACD screening may impose upon them.

Screening for SACD can have a negative impact on an individual that is greater than there risk of dying. Its important we present balanced arguments as to the pros and cons of screening going forward.

Dr Jonathan Hanson
Sport and Exercise medicine specialist/ Rural practitioner. Skye.

Maron BJ. Prevalence of Hypertrophic Cardiomyopathy in a General Population of Young Adults. Circulation. 1995;92:785-789

Elliott PM, Gimeno JR, Thaman R, et al. Historical trends in reported survival rates in patients with hypertrophic cardiomyopathy. Heart. 2006;92:785-791.
Thornton EW et al. Anxiety, Depression and Myocardial Infarction: A Survey of Their Impact on Consultation Rates Before and After an Acute Primary Episode Br J Cardiol. 2006;13(3):220-224.Thornton EW et al. Anxiety, Depression and Myocardial Infarction: A Survey of Their Impact on Consultation Rates Before and After an Acute Primary Episode Br J Cardiol. 2006;13(3):220-224.