The article describes a study from Italy that reports that rates of sudden cardiac death fell after a screening program with EKG prior to sports participation was instituted. The article does a nice job of including cost and harms information. Letting readers know that screening can lead to unnecessary procedures (which have risks) is particularly valuable, given that many people perceive screening programs to be harmless. The story also provides statements to caution readers about the strength of the evidence, although the fact that this was a population-based cohort study which could not account for all confounders could have been clearer. The article reports benefits in relative terms; providing absolute reductions would have been best particularly because the relative reduction of 89% looks quite large, but the absolute risk is small in the first place and the risk reduction is even smaller. The article also does not describe any alternatives to screening with EKG. Often athletes do have a history and physical before participation and an accompanying editorial published with the study points out that this type of screening may be just as effective as screening with EKG, but we just don’t know.
Overall, a balanced presentation, in only 600 words.
The article provides a cost of $20,000 a year for an EKG screening program at one U.S. university. The article also states that if the U.S. adopted such a screening program, approximately 10 million people per year would need to be screened. Yet, it is hard to extrapolate these costs to those of a national screening policy. A key point raised by Dr. Thompson is that the costs need to include not just those associated with the EKG and its interpretation, but also the costs of “false positives” – meaning the workup and potential unnecessary interventions associated with an abnormal screening test.
The story tells readers an 89% reduction in deaths occured, but this is a relative reduction – not an absolute figure. Absolute data is best. One could be aware that the absolute risk is extremely small to begin with and even smaller with screening, but the nature of how small the absolute risk is could be spelled out more clearly. For example, x deaths per million vs. y deaths per million.
An independent source points out that screening can be harmful if abnormalities that would never have caused problems are identified, potentially exposing people to unnecessary procedures, which have risks. Another harm is that two percent were excluded from athletics. Clearly fewer than that are at risk for death. So many individuals are labeled with a problem that may not have any dire consequences and may be led to believe that they can’t exercise when in fact they could.
This is a population-based observational study, which is not explicit from the story. However, the story tells readers that researchers analyzed trends in sudden deaths from heart problems before and after a screening program in the Veneto region of Italy. An astute reader could probably pick this up from the article. The article points out some limitations of the study (but not all), which serves to caution readers about the strength of the study (it’s not a randomized controlled trial and one cannot be certain that the decrease in death was due to the program).
The article briefly describes the problem of sudden death in athletes, describing an estimated number of deaths per year and providing some causes. The article appropriately states this occurs in ~25 individuals each year out of many million.
The article does obtain independent input from a doctor at the Minneapolis Heart Institute (who praises the research but also points out such screening is unlikely in the U.S.) and the article also incorporates information from a published editorial accompanying the journal article. The editorial points included in the article provide balance and serve to caution readers about the findings.
One alternative to screening with EKG prior to sports participation is not screening at all, but a more common alternative is screening with a pre-participation history and physical (vs. an EKG). These options are not mentioned at all. The article presents the options as EKG vs. nothing. This is not the case. A physical examination with attention to the heart and lungs would be an alternative.
EKG (electrocardiogram) testing/screening prior to participation in sports is not widely available in the U.S. and the story tells readers that only a handful of universities participate in pre-participation screening using EKG. In the absence of a standard screening policy, different screening standards would be applied. In general, universities are likely to have a health facility that could perform the test. Smaller schools or high schools may not.
The article states that EKG screening prior to sports participation does not routinely occur in the U.S., although Italy has instituted a program since 1982. So, this screening would not be “new” in and of itself, but applying it as a standard recommendation across the U.S. would be new, and the story does a good job of explaining that.
Because the story relied on several independent sources, it seems safe to assume that it did not rely solely or largely on a news release.
Systematic, Criteria-Driven
Monday at #ADA2021, an infectious disease epidemiologist, a journalist, and a researcher shared perspectives on communication of risk in the era of COVID-19: http://ow.ly/ROfR30rMeE7 @AstleyCM @garyschwitzer @berthahidalgo @ADA_DiabetesPro
Shoutouts to @susan_bewley @drkevinknopf @MichaelBaum11 in this call for more than fawning coverage from press releases for these kinds of stories.
Also, linked history inside goes back 5 years just on Grail apparently trying to become Holy Grail. https://twitter.com/garyschwitzer/status/1408849696416841731
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