AMSSM Position Statement on Cardiovascular Preparticipation Screening in Athletes: Current evidence, knowledge gaps, recommendations and future directions
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Abstract
Cardiovascular screening in young athletes is widely recommended and routinely performed
prior to 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 cardiovascular screening
in athletes remains an issue of considerable debate. At the centre of the controversy
is the addition of a resting 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 cardiovascular screening in athletes from the perspective of a primary
care sports medicine physician. The absence of definitive outcome-based evidence at
this time precludes AMSSM from endorsing any single or universal cardiovascular screening
strategy for all athletes, including legislative mandates. This statement presents
a new paradigm to assist the individual physician in assessing the most appropriate
cardiovascular screening strategy unique to their athlete population, community needs
and resources. The decision to implement a cardiovascular screening programme, 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. AMSSM 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.
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