Cardiology · Public Health · 2 h ago
Evidence and challenges in cardiac screening of young people
A review examines screening approaches for detecting inherited cardiac conditions linked to sudden cardiac arrest and death in young people. Observational evidence suggests potential benefit, but findings vary across settings and do not establish that screening reduces deaths; AI-enabled ECG approaches also require validation in young cohorts.
- Screening programmes differ across countries and populations.
- UK programme ECG sensitivity was 75.4%.
- Evidence for mortality benefit is mainly observational.
- AI-enabled ECG requires validation in young cohorts.
Sudden cardiac arrest and death in people under 35 are often linked to clinically silent inherited or congenital cardiac conditions. This review describes screening approaches that combine a health and family-history questionnaire, physical examination and 12-lead ECG, with echocardiography in some programmes. Policies differ: some settings screen athletes, while Japan screens schoolchildren and the UK does not have a national programme for asymptomatic young people.
Evidence on outcomes is largely observational. In a UK voluntary programme, 104,369 people aged 14–35 were screened from 2008 to 2018. Of those, 2.5% were referred after initial assessment; 280 people (0.27% of those screened) were diagnosed with a condition associated with sudden cardiac arrest or death, and 41% of those diagnosed received risk-modifying interventions. ECG sensitivity was 75.4%, compared with 32.5% for the questionnaire. In Italy, screening of competitive athletes coincided with an almost 90% decline in sudden cardiac death over 25 years, but Israeli data found no meaningful change.
The authors argue that screening may help identify at-risk individuals, while noting that screening effects are difficult to separate from changes in diagnosis and access to defibrillators. There are no randomised trials establishing mortality benefit, and false positives and false negatives remain concerns. AI-enabled ECG may improve detection or risk prediction, but requires validation in young populations.
In practice
For clinicians involved in the care of young people, the review describes ECG-based screening as one way to identify some inherited conditions associated with sudden cardiac arrest or death, particularly in athlete screening programmes. However, evidence that screening reduces mortality is predominantly observational and inconsistent across countries; the UK voluntary programme also missed some cases. These findings do not establish a basis for universal screening or a change in practice. AI-enabled ECG remains investigational in this population and requires validation.
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PLOS Medicine: Cardiac screening in the young for the detection of cardiovascular disease and prevention of sudden cardiac death ↗This is an automated AI-condensed summary that has not yet been reviewed by an editor. Always consult the full item at the original source.