AMSSM Position Statement on Cardiovascular Preparticipation Screening in Athletes: Current Evidence, Knowledge Gaps, Recommendations, and Future Directions

Drezner, Jonathan A. MD; O'Connor, Francis G. MD, MPH; Harmon, Kimberly G. MD; Fields, Karl B. MD; Asplund, Chad A. MD; Asif, Irfan M. MD; Price, David E. MD; Dimeff, Robert J. MD; Bernhardt, David T. MD; Roberts, William O. MD, MS

Clinical Journal of Sport Medicine:
doi: 10.1097/JSM.0000000000000382
Position Statement
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Abstract

ABSTRACT: Cardiovascular (CV) screening in young athletes is widely recommended and routinely performed before participation in competitive sports. While there is general agreement that early detection of cardiac conditions at risk for sudden cardiac arrest and death (SCA/D) is an important objective, the optimal strategy for CV screening in athletes remains an issue of considerable debate. At the center of the controversy is the addition of a resting electrocardiogram (ECG) to the standard preparticipation evaluation using history and physical examination. The American Medical Society for Sports Medicine (AMSSM) formed a task force to address the current evidence and knowledge gaps regarding preparticipation CV screening in athletes from the perspective of a primary care sports medicine physician. The absence of definitive outcomes-based evidence at this time precludes AMSSM from endorsing any single or universal CV screening strategy for all athletes including legislative mandates. This statement presents a new paradigm to assist the individual physician in assessing the most appropriate CV screening strategy unique to their athlete population, community needs, and resources. The decision to implement a CV screening program, with or without the addition of ECG, necessitates careful consideration of the risk of SCA/D in the targeted population and the availability of cardiology resources and infrastructure. Importantly, it is the individual physician's assessment in the context of an emerging evidence base that the chosen model for early detection of cardiac disorders in the specific population provides greater benefit than harm. American Medical Society for Sports Medicine is committed to advancing evidenced-based research and educational initiatives that will validate and promote the most efficacious strategies to foster safe sport participation and reduce SCA/D in athletes.

Author Information

*Department of Family Medicine, University of Washington, Seattle, Washington;

Department of Military and Emergency Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland;

Department of Family Medicine, University of North Carolina, Greensboro, North Carolina;

§Department of Health and Kinesiology, Georgia Southern University, Statesboro, Georgia;

Department of Family Medicine, University of South Carolina Greenville School of Medicine, Greenville, South Carolina;

Department of Family Medicine, Carolinas Healthcare System, Charlotte, North Carolina;

Departments of **Orthopedic Surgery;

††Family and Community Medicine; and

‡‡Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas;

Departments of §§Pediatrics; and

¶¶Orthopedics and Rehabilitation, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin; and

‖‖Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, Minnesota.

Corresponding Author: Jonathan A. Drezner, MD, Department of Family Medicine, University of Washington, Box 354060, Seattle, WA 98195 (jdrezner@uw.edu).

The authors report no conflicts of interest. Please see Appendix, Supplemental Digital Content 1, http://links.lww.com/JSM/A116, for a list of volunteer positions, board and other affiliations.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.cjsportmed.com).

J. A. Drezner and F. G. O'Connor are the Co-Chairs.

Received July 18, 2016

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