Abstract

Background High false positive rates and the subsequent cost of additional investigations provide a major obstacle to screening young athletes for cardiac disease with an electrocardiogram (ECG). However, the actual cost of ECG has never been assessed systematically in a large cohort of athletes. Objective This study investigated the financial implications associated with ECG interpretation in athletes according to the 2010 European Society of Cardiology (ESC) and the more contemporary Seattle and refined ECG interpretation criteria. Methods Between 2011 and 2014, 4,925 previously unscreened athletes aged 14-35 years were prospectively evaluated with history, physical examination and an ECG interpreted with the 2010 ESC recommendations. Athletes with abnormal results underwent secondary investigations, the costs of which were based on the UK National Health Service Tariffs. The impact on cost after applying the Seattle and refined criteria was evaluated retrospectively. Results 1,072 (21.8%) athletes revealed an abnormal ECG based on the 2010 ESC recommendations. 11.2% athletes required echocardiography, 1.7% exercise stress test, 1.2% Holter, 1.2% cardiac MRI and 0.4% other tests. The Seattle and refined criteria reduced the number of positive ECGs to 6.0% and 4.3% respectively. 15 (0.3%) athletes were diagnosed with potentially serious cardiac disease using all three criteria. The overall cost of de-novo screening using the 2010 ESC recommendations amounted to $539,888, equating to $110 per athlete and $35,993 per serious diagnosis. The Seattle and refined criteria reduced the cost to $92 and $87 per athlete screened and $30,251 and $28,510 per serious diagnosis respectively, representing a 21% cost saving per athlete screened. Conclusion Contemporary ECG interpretation criteria are associated with significant cost reductions for a de-novo screening program in athletes which may be cost permissive for some financially endowed sporting organisations.