Bill Screening Student Athletes for Cardiac Trouble Prescribes EKGs as Needed

Andrew Kitchenman | April 3, 2013 | Health Care
Physical checkup and family medical histories help determine when further tests are necessary

While electrocardiograms are becoming more routine as part of the checkup given to student athletes, they’re not mandatory under a bill meant to identify heart problems in junior jocks in the sixth through 12th grades.

What the Scholastic Student-Athlete Safety Act S-1912 does require is that students who want to make the team have a physical and answer questions about their health history. Those whose exams or histories indicate a need for an EKG would receive one.

The Senate passed the bill in February; the Assembly, in March.

While some doctors advocate EKGs for all student athletes, a task force formed by the Legislature to explore the issue determined that the tests shouldn’t be a requirement.

Task force member Dr. Louis E. Teichholz, a cardiologist, said the bill reflects the latest thinking in medical science. It requires doctors, advanced practice nurses, and physician assistants who give kids physicals to complete professional development that will bring them up to date about risks to athletes’ hearts.

“A lot of times it’s a family physician who does not know about the diseases we’re looking for,” Teichholz said.

Task force chairman Dr. Stephen G. Rice said it’s important that doctors performing the exams update their knowledge of student cardiac health, rather than rely just on information they learned in medical school.

The state would also require that a pamphlet about heart risks be distributed to student athletes and their families.

Teichholz said that understanding the health histories of both the students and their families is a major component of the legislation. Doctors increasingly have recognized the importance of family medical history in assessing a student’s hereditary risk for heart problems.

The bill stopped short of requiring EKGs, a step that some doctors and families had supported.

“If you go into just about every major cardiology journal, every year there are pro and con” articles on whether to make EKGs mandatory, Teichholz said.

He noted that there are two downsides to making EKGs universal: the cost and the risk that the tests would misclassify students with normal hearts as having an abnormal condition.

“It is not cost-effective to screen everybody,” Teichholz said.

While the task force has completed its work, Teichholz said he expects that its members will continue to keep an eye on whether the law needs to be revised.

Pediatric cardiologist Dr. Victoria L. Vetter, who practices in New Jersey and at the Children’s Hospital of Philadelphia, supported the bill at a committee hearing.

She noted that ventricular fibrillation is the leading cause of death among young athletes. But asking a series of health-history questions as part of an overall evaluation, she commented, can help identify half of all potential student cardiac deaths in which warning signs are present.

“For children living with undiagnosed cardiac disease, this type of evaluation can mean the difference between life and death, because all of these conditions are treatable if they are identified,” said Vetter, who described the bill as a “tremendous step forward for the athletes in this state.”

Rice said the Legislature is on track to adopt eight of the task force’s nine recommendations. While legislators have endorsed having a defibrillator in every school, the task force suggested that one of the devices be within 90 seconds of each school athletic facility.

Gov. Chris Christie now must decide whether to sign the bill. It was [|one of three sponsored] by Sen. Fred H. Madden Jr. (D-Camden and Gloucester) dealing with student heart health

Another bill (S-1911) would require that all children’s sudden cardiac events be reported to a statewide registry. That measure was passed by the Senate and has been referred to the Assembly Appropriations Committee.

The third bill (S-1910) would require insurance companies to cover the student exams. It’s been referred to the Senate Budget and Appropriations Committee.