Application of the International Recommendations for Electrocardiographic Interpretation in Athletes for pre–participation electrocardiography (ECG) in young athletes reduced costs, workload and subsequent cardiovascular testing, according to a letter published July 31 in the Journal of the American College of Cardiology.

Written by Harshil Dhutia, BSc, et al., the letter addresses outcomes from a previously published study, in which 4,925 previously unscreened athletes from 26 sporting disciplines were evaluated between 2011 and 2014 by cardiologists following the recent international recommendations. Of the total study population, only 146 athletes had a positive ECG and were referred to a local hospital for secondary investigations. After undergoing transthoracic echocardiography (3.8 percent), exercise stress testing (1.2 percent), Holter monitoring (1 percent), cardiac magnetic resonance imaging (MRI) (0.9 percent) or other tests, a total of 15 athletes were diagnosed with serious cardiovascular diseases.

The authors note that “The figures equate to a 66% reduction in the number of echocardiograms, a 29% reduction in the number of exercise stress tests, a 17% reduction in Holter monitoring, and a 25% reduction in the number of cardiac MRI scans compared with the 2010 European Society of Cardiology ESC recommendations.”

Application of the international recommendations also resulted in lower overall cost of screening per athlete and per serious diagnosis. Compared with the 2010 ESC recommendations, the cost per athlete when following international recommendation was reduced from $110 to $80, whereas cost per serious diagnosis dropped from $35,993 to $26,405.

“The international recommendations are associated with a significantly lower number of abnormal ECGs and result in an impressive reduction in workload and cost of screening without compromising the ability to detect athletes with serious cardiac disease,” state the authors. “Prospective evaluation is required to understand the actual impact of this consensus document on testing, cost, and outcomes.”