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Usefulness and Cost Effectiveness of Cardiovascular Screening of Young Adolescents

TANAKA, YUJI1; YOSHINAGA, MASAO1; ANAN, RYUICHIRO2; TANAKA, YASUHIRO2; NOMURA, YUICHI2; OKU, SHOZO3; NISHI, SEIJI3; KAWANO, YOSHIFUMI2; TEI, CHUWA2; ARIMA, KATSURA3

Medicine & Science in Sports & Exercise: January 2006 - Volume 38 - Issue 1 - pp 2-6
Clinical Sciences: Clinical Investigations

Objectives: This study was conducted to assess the usefulness of a screening system for cardiovascular disease in Kagoshima, Japan, and to compare its cost-effectiveness with that of a similar system reported in the United States.

Background: Preparticipation screening of young athletes has been implemented in many countries to prevent sudden death, but sudden death in young nonathletes remains a problem. In Japan, both athletes and nonathletes have been screened for the presence or absence of cardiovascular diseases for more than 20 yr.

Methods: From 1989 to 1997, all seventh graders in schools in Kagoshima, Japan, were screened for cardiovascular disease using a questionnaire and electrocardiogram before physical examination. They were screened again in the same way 3 yr later. One subject newly diagnosed with cardiovascular disease and recommended to limit athletic participation was defined as “high-risk.” Situations leading to cases of sudden death were verified with a report from the school in question.

Results: Of the initial study population, 99% participated in the program every year. A total of 37,807 subjects, including nine high-risk subjects, were evaluated consecutively for 6 yr. Of these nine subjects, six, including three patients with hypertrophic cardiomyopathy, were nonathletes. Three sudden deaths occurred during the study period; one student was from the high-risk group. The cost of this screening system was lower than that reported in the United States.

Conclusions: Population-based screening for heart disease in this age range is limited by various factors. To analyze the mechanisms of sudden death in adolescents, we, therefore, are in need of a nationwide registry that includes autopsies for all deadly events.

1National Hospital Organization Kyusyu Cardiovascular Center, Shiroyamacho, Kagoshima City, Kagoshima, JAPAN; 2Graduate School of Medical and Dental Sciences, Kagoshima University, Sakuragaoka, Kagoshima City, Kagoshima, JAPAN; and 3Kagoshima City Medical Association, Kajiyacho 3-10, Kagoshima City, Kagoshima, JAPAN

Address for correspondence: Masao Yoshinaga, National Hospital Organization Kyusyu Cardiovascular Center, Shiroyamacho 8-1, Kagoshima City, Kagoshima, 892-0853, Japan; E-mail: m-yoshi@q-jun2.hosp.go.jp.

Submitted for publication February 2005.

Accepted for publication August 2005.

The authors thank the physicians and participants who made essential contributions to this study.

©2006The American College of Sports Medicine