Implementing Sudden Cardiac Death Risk Screening Within a Pediatric Primary Care Network

Area of Science:

• Pediatric Cardiology
• Preventive Medicine
• Public Health

Background:

• The American Academy of Pediatrics (AAP) updated recommendations in 2021 for universal, history-based sudden cardiac death risk screening in children.
• This expanded screening aims to identify more at-risk individuals compared to previous history- and exam-based methods.
• Understanding implementation workflows and system effects is crucial for widespread adoption in pediatric primary care.

Purpose of the Study:

• To evaluate the implementation of universal cardiac risk screening in a large pediatric primary care network.
• To assess screening positivity rates and identify optimal workflow designs.
• To examine potential system-based effects and disparities in screening rates.

Main Methods:

• Adapted AAP guidelines into a three-question screener integrated into the electronic health record (EHR) via patient portal.
• Established a paper-based backup workflow for patients without portal access.
• Utilized non-interruptive alerts for clinical decision support and measured screening and follow-up rates; analyzed demographic associations with screening.

Main Results:

• Of 72,037 eligible patients, 41,433 (58%) completed screening between March 2024 and February 2025.
• A clinically actionable positive screen was identified in 3,463 patients (8.4%).
• Follow-up evaluations were ordered in only 31% of positive cases; lower screening rates were linked to inactive portal status, older age, unknown race, and public insurance.

Conclusions:

• Universal history-based screening yielded an 8.4% positivity rate, indicating a significant potential need for cardiology referrals.
• Screening adoption and adherence to follow-up protocols were suboptimal, with over half of eligible patients not screened and a minority of positive screens leading to evaluation.
• Implementation highlighted disparities, with lower screening rates observed in specific disadvantaged populations.