Doctors or athletes: who should have the last word?

A recent study promotes ECGs to monitor heart health, but they may not help if athletes can choose to ignore them.

Nicolas Hallett

Wes Leonard was the star of the Fennville, Mich., high school basketball team. On March 3, in overtime of FennvilleâÄôs most important game of the year, Leonard drove to the basket and scored the game-winning layup with only 30 seconds remaining.

Minutes later, Leonard, 16, collapsed on the court and later died of an enlarged heart.

Sadness doesnâÄôt begin to describe the event, but researchers at the University of Washington are hoping science can at least explain it.

In the April edition of âÄúCirculationâÄù, published by the American Heart Association, a team led by sports medicine specialist Dr. Kimberly Harmon reported on the occurrence of sudden cardiac death in NCAA athletes.

Using NCAA data on athlete deaths, media reports and insurance records, the study discovered 45 heart-related deaths in the five-year period between 2004 and 2008, an average of nine per year. That translates to about one death for every 44,000 NCAA athletes.

The study also found that âÄúby farâÄù basketball was the sport with highest risk of SCD. Next on the list is swimming, followed by lacrosse, football and cross country.

âÄúThe question is, âÄòwhat do we do with this information?âÄôâÄù University of Minnesota physician and cardiologist Scott Sakaguchi said.

One suggestion for prevention is to add electrocardiographs âÄî or ECGs âÄî which measure the heartâÄôs electric activity to athletesâÄô routine medical checkups.

The AHA doesnâÄôt require ECG scans for athletes, but the NCAA could make them mandatory, as they are in European athletics. Overseas, the policy originated in Italy where, in addition to the included ECG, all athletes must go through medical screening by a doctor trained in sports medicine, Sakaguchi said.

This sharply contrasts U.S. policy where, as of 2007, 18 states allowed chiropractors and naturopathic physicians âÄî nontraditional doctors who use techniques such as acupuncture and herbal medicine âÄî to screen athletes, according to âÄúCirculation.âÄù

Sakaguchi described this policy as âÄúa little looseâÄù and added, âÄúour attitude in this country is a little different. ItâÄôs kind of ignorant.âÄù

So should ECGs be made mandatory in the U.S.?

âÄúItâÄôs not as clear cut as you might think,âÄù Sakaguchi said. âÄúThe AHA needs something that can be easily applied throughout the country.âÄù

With each ECG scan costing about $100, one concern is expense. Another is test accuracy: The study found ECGs to be anywhere from 66 to 100 percent effective in detection, with 2 percent of results being âÄúfalse-positives.âÄù

A third issue is one of a doctorâÄôs influence over his patients. In the U.S., team doctors can be pressured by coaches and parents to clear players for competition, and some athletes are playing not for fun but in pursuit of a future paycheck. In many cases, team doctors can tell athletes not to play, but players ultimately make the call.

âÄúIn Europe physicians have the final say on whether an athlete can compete or not,âÄù Sakaguchi said. âÄúThey are focused on protecting the population as a whole. In the U.S., our philosophy is focused on individual freedom.âÄù