PACES Survey

1. PACES Survey ECG Screening November 2008 AHA Stuart Berger Robert Campbell Jonathan Drezner

2. The Survey • Web-based survey • Posted for two weeks to all PACES members • Survey closed 11-7-08 • Data compiled for presentation • A spring-board for future discussions • n = 88

3. Do you agree with the 2007 American Heart Association pre-participation screening guidelines, which does not advocate for routine ECG screening as part of the athletic pre-participation screening? 

4. Do you personally believe routine ECG’s should be performed on all high school athletes?  12% 34% 54%

5. If yes, how many times should high school students be screened with an ECG?

6. Do you personally believe routine ECG’s should be performed on all college athletes? 11% 47% 42%

7. If yes, how many times should college students athletes be screened with an ECG?

8. Do you personally believe routine ECG’s should be performed on all children in organized sports? 9% 15% 76%

9. Do you personally believe routine ECG’s should be performed on all ADD/ADHD patients? 4% 13% 83%

10. Do you personally believe routine ECG’s should be performed on all of our youth? 8% 80%

11. Personal beliefs of routine ECGs by PACES members with regard to ECG screening in

12. Do you personally participate in an ECG screening activity now?  Yes n = 30 30% 30% 70%

13. Do physicians in your practice use a standard consistent published table of ECG normal values for interpretation of ECG’s in young athletes?  40% 60%

14. What do you believe is the false-positive rate of ECG screening in young athletes (age 14-22)?

15. If the false-positive rate was 5% using pre-established ECG criteria to distinguish normal from abnormal, would you be in favor of ECG screening during the athletic pre-participation evaluation? • PLEASE BE SURE THAT YOU UNDERSTAND THE FOLLOWING IN ANSWERING THIS QUESTION: A false positive rate of 5% with an incidence of SCD of 1 in 1000 means that there will be 50 false positives and 1 true positive per 1000 screened or a 2% positive predictive value.

16. If the false-positive rate was 5% using pre-established ECG criteria to distinguish normal from abnormal, would you be in favor of ECG screening during the athletic pre-participation evaluation? 35% 65%

17. If the false-positive rate was 2% using pre-established ECG criteria to distinguish normal from abnormal, would you be in favor of ECG screening during the athletic pre-participation evaluation? • PLEASE BE SURE THAT YOU UNDERSTAND THE FOLLOWING IN ANSWERING THIS QUESTION: A false positive rate of 2% with an incidence of SCD of 1 in 1000 means that there will be 20 false positives and 1 true positive per 1000 screened or a 5% positive predictive value.

18. If the false-positive rate was 2% using pre-established ECG criteria to distinguish normal from abnormal, would you be in favor of ECG screening during the athletic pre-participation evaluation? 39% 61%

19. Would you support a PACES initiative to evaluate the applicability of routine ECG screening for certain pediatric patient populations?  Yes or No 9% 91%

20. Would you support a PACES initiative to evaluate the applicability of routine ECG screening for certain pediatric patient populations?  Athletes 8% 92%

21. Would you support a PACES initiative to evaluate the applicability of routine ECG screening for certain pediatric patient populations?  ADHD 42% 58%

22. Would you support a PACES initiative to evaluate the applicability of routine ECG screening for certain pediatric patient populations?  All 46% 54%

23. Summary of Support for PACES Initiative(s) to Evaluate applicability of ECG screening

24. Do you/your group advocate use of a specific standardized athletic pre-participation history/pre-participation evaluation form? 39% 61%

25. Additional Comments • SCD occurs in 1/1000 of what group: CHD, syncope, CP, HCM? • What specific diseases are we screening for (each has a level of ECG precision); maybe specifically HCM, LQT, WPW • You address the age of the 1st ECG question pretty well, but not the derivative question of repeated ECGs in those who pass the initial screen • What cutoff LQT would people be willing to use for an ECG based referral • Might be worth asking what confidence people have in making a firm diagnosis/exclusion (both) of LQT with different QTc of 44, 45, 46, 47, 48

26. Summary/Next Steps? • Athletes seem to be the most compelling group to discuss • 30% do some sort of ECG screening now; exactly what type and how? • 60% use published table of normal ECG criteria in evaluation of athletes • Only 60% use a standard PPE form; can we make this 100%? • Didn’t include neonates in the survey

27. Summary/Next Steps? • False positives with ECG screening: we are only guessing; most of us believe 5-10% • Corrado 8% • Fuller 15% • There seems to be an overwhelming interest in PACES taking the initiative to evaluate the applicability of ECG screening • Athletes >>> All children > ADHD

28. Summary/Next Steps? • False positives with ECG screening: we are only guessing; most of us believe 5-10% • Corrado 8% • Fuller 15% • There seems to be an overwhelming interest in PACES taking the initiative to evaluate the applicability of ECG screening • Athletes >>> All children > ADHD How might we go forward? A follow-up future symposium?