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Comparative performance of wearable ECG devices for rhythm monitoring in endurance athletes.

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ECG-based cardiac screening programs: Legal, ethical, and logistical considerations.

Jessica J Orchard1, Lis Neubeck2, John W Orchard3

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Heart Rhythm
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PubMed
Summary

Screening asymptomatic individuals with electrocardiograms (ECG) may detect heart disease, but is not recommended for all. This review examines screening elite athletes for sudden cardiac death (SCD) and older adults for atrial fibrillation (AF).

Keywords:
AthletesAtrial fibrillationEthicalLegalScreeningSudden death

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Area of Science:

  • Cardiology
  • Preventive Medicine
  • Medical Ethics

Background:

  • Resting electrocardiograms (ECG) are theorized to detect latent cardiovascular disease in asymptomatic individuals.
  • ECG screening is not universally recommended, particularly for sedentary middle-aged populations due to insufficient sensitivity for coronary artery disease.
  • Screening programs face ethical, legal, and logistical challenges, necessitating careful consideration of implementation and oversight.

Purpose of the Study:

  • To review the complexities and considerations for implementing ECG screening programs.
  • To focus on two specific screening contexts: elite athletes for sudden cardiac death (SCD) and individuals aged 65+ for atrial fibrillation (AF).
  • To highlight the importance of quality control, expert guidelines, and follow-up care in screening.

Main Methods:

  • This is a review article, synthesizing existing knowledge and guidelines on ECG screening programs.
  • The review specifically analyzes screening protocols for elite athletes and older adults.
  • Considerations for legal, ethical, and logistical responsibilities are discussed.

Main Results:

  • ECG screening effectiveness varies by population; it's not suitable for all asymptomatic individuals.
  • Screening elite athletes for SCD and older adults for AF presents unique challenges and benefits.
  • Effective screening requires robust infrastructure for interpretation, follow-up, and treatment pathways.

Conclusions:

  • Screening programs must be well-executed, addressing legal, ethical, and logistical aspects from start to finish.
  • Proper infrastructure, adherence to guidelines, and clear follow-up protocols are crucial for quality screening.
  • Diagnosed cardiac conditions can have significant implications for insurance, employment, and mental health, necessitating careful management and communication.