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Title: General population screening for sudden cardiac death in young individuals : the UK experience
Author: Chandra , Navin
ISNI:       0000 0004 5367 8907
Awarding Body: St George's, University of London
Current Institution: St George's, University of London
Date of Award: 2015
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BACKGROUND: Sudden cardiac death (SCD) in any young person is a tragic event with a significant number of life-years lost. Previous data from Italy suggest that pre-participation screening using an electrocardiogram (ECG) reduces the incidence of SCD in competitive athletes. However, the majority of SCD occurs in non-athletes within the general population. In the United Kingdom, state sponsored screening for cardiac disorders is confined to symptomatic individuals or those with a family history of inherited cardiac conditions or premature cardiac death. AIMS: To assess the feasibility and efficacy of screening, incorporating an ECG and point-ofcare echocardiography, in young individuals from the general population for cardiovascular conditions associated with SCD. METHODS: Between 2008-2012, 10,359 young individuals aged 14-35 years underwent screening by an attending cardiologist comprising a health questionnaire, physical examination and ECG. ECGs were analysed in accordance with the European Society of Cardiology (ESC} recommendations for ECG interpretation in athletes for Group-1 (trainingrelated) and Group-2 (potentially pathological) patterns. Group-2 ECG patterns warrant further cardiac evaluation. Individuals with findings raising suspicion of cardiomyopathy underwent on-site echocardiography. Individuals with abnormalities from the screening episode were referred for further evaluation for conditions associated with SCD and followed up annually to assess outcomes. Based on these data comparisons of the efficacy of different screening strategies were made and costs and cost effectiveness were calculated. RESULTS: Symptoms of a cardiovascular nature were reported in 44.2% of individuals, a family history of SCD or condition associated with SCD was reported in 3.8% and an abnormal physical examination occurred in 0.3% of individuals. ECG patterns suggestive of cardiac pathology were identified in 22.4% of individuals, predominantly due to abnormalities of QTc measurement. Male gender and black ethnicity demonstrated the strongest association with ESC Group-2 ECG patterns. Point-of-care echocardiography for individuals with suspicion of cardiomyopathy significantly reduced the number of patients requiring further evaluation as only 14.8% of these individuals demonstrated abnormal echocardiographic findings. Positive diagnosis of a cardiovascular condition associated with SCD was identified in 0.3% of individual;; (cardiomyopathy, n=6; primary electrical disease, n=17; Marfan syndrome, n=4). This screening strategy demonstrated a sensitivity of 100%, specificity of 93.2% and false-positive rate of 6.8% with an estimated cost of £106,141 per diagnosis made. CONCLUSIONS: Screening for conditions associated with SCD in the general population is feasible. A screening strategy incorporating the ECG and point-of-care echocardiography is associated with a high sensitivity and specificity and low false-positive rate as well as favourable cost analyses.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (M.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available