Sudden deaths among young athletes in Italy declined drastically after a screening program was introduced to look for unsuspected heart problems, but it may not be an approach Canada wants to follow.

Since 1982, Italy has required all athletes participating in competitive sports to have a medical exam, including a physical, heart history and an electrocardiogram (ECG) to look for potentially deadly heart problems.

Italy requires all athletes to get medical certification before participating in sports.
(Bjorn Sigurdsoen/Associated Press)

When Dr. Gaetano Thiene's team at the Padua Centre for Sports Medicine looked at the incidence of sudden heart-related deaths among athletes aged 12 to 35 after the screening program was introduced, they found they had decreased by 89 per cent from 1979-1980 to 2003-2004.

"These findings suggest that screening athletes for cardiomyopathies is a life-saving strategy," the study's authors wrote in Wednesday's issue of JAMA. "These data demonstrate the benefit of the current Italian screening program and have important implications for implementing screening strategies for prevention of sudden death in athletes in other countries."

During the study period, there were 55 sudden heart-related deaths among athletes who were screened, compared with 265 among unscreened non-athletes, the team reported. They said the screenings cost an estimated $40 US per athlete.

The incidence of sudden death among non-athletes who were not screened did not change much, the study said.

Less formal screening just as good?

The annual death rate achieved with screening was similar to that reported for high school and college athletes in the U.S. between 1983 and 1993, according to a study cited in an editorial accompanying the study.

"Nevertheless, such results suggest that the less formal screening process practised in the United States at that time may have been as effective as the more formal Italian program," cardiologists Dr. Paul Thompson and Dr. Benjamin Levine of Hartford, Conan., wrote in the editorial.

The editorial concludes the study "provides the best evidence to date supporting the pre-participating screening of athletes and provocative evidence for including ECGs in this process."

Roy Shephard, a professor emeritus in physical education and health at the University of Toronto, has been calling on the Italian researchers for years to show death rates are lower thanks to the testing.

"Seems to me it's like using a sledgehammer to crack a walnut," Shepherd said in an interview from Vancouver, referring to the use of costly ECG tests that may be too imprecise to detect such a rare condition, leading to many false positive results.

Both Shephard and the editorial writers point to weaknesses in the study, including:

• Since all athletes had the sophisticated tests, there was no way to compare them to a group who did not.
• Other factors may have helped reduced deaths, such as better advice from coaches or family doctors on treating heat stress.
• Use of ECGs was not compared with asking athletes about their family history of cardiomyopathy – the main cause of death of exercise-related sudden death in the U.S., which tends to run in families.

Among a parallel group of more than athletes who were screened at Thiene's centre, about two per cent were disqualified from participating in competitive sports. These people may worry about their heart health and become inactive, increasing their risk for heart disease, Shephard said.

"You may have saved a few deaths on the sports field, but you may have produced many more deaths at 40 or 50 from heart disease."