TY - JOUR
T1 - Quality of athlete screening for high-risk cardiovascular conditions—A systematic review
AU - Panhuyzen-Goedkoop, Nicole M.
AU - Verbeek, André L. M.
AU - Goedkoop, René J.
AU - Malekzadeh, Arjan
AU - Wilde, Arthur A. M.
AU - Peters, Ron J. G.
AU - Jørstad, Harald T.
N1 - Publisher Copyright: © 2023 The Authors. Scandinavian Journal of Medicine & Science In Sports published by John Wiley & Sons Ltd.
PY - 2023/11
Y1 - 2023/11
N2 - Background: Sudden cardiac death (SCD) is the leading medical cause of death in athletes. To prevent SCD, screening for high-risk cardiovascular conditions (HRCC) is recommended. Screening strategies are based on a limited number of studies and expert consensus. However, evidence and efficacy of athlete HRCC screening is unclear. Objective: To determine methodological quality and quality of evidence of athlete screening, and screening efficacy to detect HRCC in a systematic review. Methods: We performed a systematic search of Medline, Embase, Scopus and Cochrane Library up to June 2021. We included articles containing original data of athlete cardiovascular screening, providing details of screening strategies, test results and HRCC detection. We assessed methodological quality of the included articles by QUADAS-2, quality of evidence of athlete HRCC screening by GRADE, and athlete HRCC screening efficacy by SWiM. Results: Of 2720 citations, we included 33 articles (1991–2018), comprising 82 417 athletes (26.7% elite, 73.4% competitive, 21.7% women, 75.2% aged ≤35). Methodological quality was ‘very low’ (33 articles), caused by absence of data blinding and inappropriate statistical analysis. Quality of evidence was ‘very low’ (33 articles), due to observational designs and population heterogeneity. Screening efficacy could not be reliably established. The prevalence of HRCC was 0.43% with false positive rate (FPR) 13.0%. Conclusions: Methodological quality and quality of evidence on athlete screening are suboptimal. Efficacy could not be reliably established. The prevalence of screen detected HRCC was very low and FPR high. Given the limitations of the evidence, individual recommendations need to be prudent.
AB - Background: Sudden cardiac death (SCD) is the leading medical cause of death in athletes. To prevent SCD, screening for high-risk cardiovascular conditions (HRCC) is recommended. Screening strategies are based on a limited number of studies and expert consensus. However, evidence and efficacy of athlete HRCC screening is unclear. Objective: To determine methodological quality and quality of evidence of athlete screening, and screening efficacy to detect HRCC in a systematic review. Methods: We performed a systematic search of Medline, Embase, Scopus and Cochrane Library up to June 2021. We included articles containing original data of athlete cardiovascular screening, providing details of screening strategies, test results and HRCC detection. We assessed methodological quality of the included articles by QUADAS-2, quality of evidence of athlete HRCC screening by GRADE, and athlete HRCC screening efficacy by SWiM. Results: Of 2720 citations, we included 33 articles (1991–2018), comprising 82 417 athletes (26.7% elite, 73.4% competitive, 21.7% women, 75.2% aged ≤35). Methodological quality was ‘very low’ (33 articles), caused by absence of data blinding and inappropriate statistical analysis. Quality of evidence was ‘very low’ (33 articles), due to observational designs and population heterogeneity. Screening efficacy could not be reliably established. The prevalence of HRCC was 0.43% with false positive rate (FPR) 13.0%. Conclusions: Methodological quality and quality of evidence on athlete screening are suboptimal. Efficacy could not be reliably established. The prevalence of screen detected HRCC was very low and FPR high. Given the limitations of the evidence, individual recommendations need to be prudent.
KW - GRADE
KW - SWiM
KW - athlete screening
KW - efficacy
KW - quality of evidence
KW - sudden cardiac death
UR - http://www.scopus.com/inward/record.url?scp=85165175391&partnerID=8YFLogxK
U2 - https://doi.org/10.1111/sms.14446
DO - https://doi.org/10.1111/sms.14446
M3 - Review article
C2 - 37449413
SN - 0905-7188
VL - 33
SP - 2094
EP - 2109
JO - Scandinavian journal of Medicine & Science in Sports
JF - Scandinavian journal of Medicine & Science in Sports
IS - 11
ER -