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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 - p 2-6
doi: 10.1249/01.mss.0000183187.88000.53
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