Canadian doctors announce cardiovascular testing guidelines for varsity athletes
Published Sunday, October 21, 2018 10:00PM EDT
Last Updated Monday, October 22, 2018 10:44AM EDT
In what they’re calling a national first, Canadian doctors have announced new cardiovascular health guidelines that they hope may save the lives of some young athletes.
The new guidelines, announced at the Canadian Cardiovascular Congress, call for nationwide screening of competitive varsity level athletes for unrecognized or overlooked heart conditions that can lead to sudden cardiac death.
While heart conditions like this are rare, with only a 1-in-300 chance of turning fatal, the doctors behind the program hope that proper screening will help Canadian athletes avoid any future tragedies – like that of Jordan Boyd.
Boyd was a 16-year-old budding hockey star from New Brunswick, who died only minutes after stepping onto the ice for a practice in 2013.
The cause of death was later determined to be an undiagnosed inherited heart condition.
“Jordan was 16 years old and had no prior history or symptoms of any kind of any cardiac issue,” his father Stephen Boyd told CTV News. “He was in peak physical condition…and this was like a lightning strike.”
‘Introducing a lot of variability’
While recommendations are in place in both Europe and the United States, there is currently no widely accepted systematic screening process in place in Canada to identify athletes at risk.
Doctors say the lack of a national position in Canada has led to a great degree of variation in how practitioners screen athletes for heart conditions, if they do so at all.
“Practitioners were taking bits and pieces of guidelines from other countries and other organizations,” Dr. Amer Johri said, “and that was introducing a lot of variability into how they were screening athletes.”
While other countries recommend Electrocardiography testing for all varsity level athletes, the Canadian team behind the guidelines recommends against this blanket approach.
Instead, they’re calling for a tiered approach for testing that targets varsity and competitive level athletes across the country.
The guidelines start small with a questionnaire, and moves on to more elaborate testing like an ECG if the situation calls for it.
The new guidelines include the idea that facilities need to create plans to ensure that proper action will be undertaken in the case of cardiovascular emergencies, creating an environment where athletes have increased chances of surviving, should an incident occur.
They recommend that all educational and recreational facilities have defibrillators on hand, and work to create a medical action plan, to ensure proper response to an emergency.
Part of ensuring preparedness is training athletes, coaches, and referees in CPR and the use of defibrillators, since they’re most likely to be nearby when a player collapses.
From there, the plan builds on other aspects of cardiovascular screening, with a testing process that begins with an initial standardized questionnaire that explores the athlete’s health conditions, as well as any hereditary conditions that they’re aware of.
These questionnaires could be done with a family doctor, a team’s medical staff, or a cardiologist – so long as they’re properly qualified.
For most athletes, this step is enough to determine that they’re safe to play.
If the questionnaire turns up anything that warrants further investigation, a physical examination is the next step.
A 12-lead ECG is the final step of the examination process, and the guidelines warn that it should only be used when results from the past two phases indicate it is necessary, and when it can be investigated clinically with consideration of sport history, gender, ethnicity, age, family history and other factors.
Any warning signs, if found, necessitate deliberation between the clinician and patient, to determine the risks, harms, and benefits of potential diagnosis and interventions.
“When we do find red flags we speak to the athlete and help them come to a decision with us,” Johri said.
“We’re not necessarily taking a paternalistic approach into telling them what to do, but we’re giving them the risks with their family and trying to come up with a plan together.”
If a heart problem is found, doctors will help athletes build a plan of action that may include further testing, continued participation with the acceptance that doing so may come at a risk, or deciding that there should be no further participation.
Researchers at Queens University have been testing the guidelines for the past two years, and are already finding positive results, with student athletes embracing the screenings.
“Just to know I’m healthy going into the upcoming season and there’s nothing that could limit my performance,” rowing team member Nicholas Grubic said, “I think that’s definitely valuable information to know.”
While all of the 400 athletes screened in the first cohort were given the go ahead to continue playing, one from the second cohort of 400 discovered a previously undetected condition.
“That red flag would not have been picked up if we had not been doing screening,” said Johri, “because the athlete was otherwise asymptomatic.”
The doctors behind the program say that they’re curious to see how other schools respond to implementing the guidelines, to see if it would be feasible to expand them to include high school athletes and even adults who play recreational sports.
With files from CTV Medical Correspondent Avis Favro and Producer Elizabeth St. Philip