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More Heart Screening Called for in College-Level Athletics

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The researchers found a team physician performed most of the physicals, but of those physicians, about three out of four of them were orthopaedic surgeons -- "clinicians who are often not as familiar with [heart] evaluations as are primary care physicians or trained [heart specialists]," the researchers write. Only 5% were doctors with formal training in heart disease.

The researchers also determined about one in four of the NCAA schools was considered to have inadequate screening forms. That means they contained four or fewer recommendations out of the 12 suggested by the American Heart Association for pre-participation screening for student athletes. Slightly more -- 26% of the schools -- were considered adequate, including at least nine of the AHA recommendations. The remainder of schools was termed "intermediate."

Henry S. Miller, MD, a cardiologist with the Wake Forest University School of Medicine in Winston-Salem, N.C., has examined many athletes in his day. He says his school had a wake-up call when a swimmer with Marfan's syndrome, a genetic condition that weakens the blood vessels and heart, died while swimming laps. Marfan's syndrome is an AHA warning sign. "We didn't know anything about his family history. ... [It was] a tragic situation ... that precipitated us getting a lot more information from family and physicians," Miller tells WebMD.

"The most important thing is to be able to get a really good history of these people," Miller says. Wake Forest uses the histories to "augment" on-campus examinations done by cardiologists, or physicians experienced with heart conditions, and orthopaedic surgeons. "Our duty is to keep them alive, and their duty is to see if they can play."

Less than 10% of schools in the JAMA survey routinely performed tests such as EKGs, chest X-rays, or echocardiograms, which can effectively find some of the heart conditions, usually congenital, that can bring on sudden death.

Division I schools, which generally have the largest intercollegiate sports programs and scholarship awards, were usually found to have more comprehensive screening programs than Division II or III schools. Beyond the standard screening, noninvasive tests like EKGs or X-rays "are costly and impractical for most schools," the authors write.

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