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

In 2021, the American Academy of Pediatrics (AAP) recommended universal, history-based sudden cardiac death risk screening, representing an expansion from history- and exam-based screening for sports preparticipation. We studied the implementation of universal cardiac risk screening within a large pediatric primary care network to better understand optimal workflow design, screening positivity rate, and potential system-based effects that may arise from expanded screening.

We adapted the AAP guidelines to a 3-question screener implemented into the electronic health record as a patient portal questionnaire with a back-up paper-based workflow. A noninterruptive alert provided clinical decision support. Screening positivity rates and rates of follow-up actions were measured. Screening rates were compared across patient demographics using a multivariable model.

Between March 1, 2024, and February 28, 2025, of 72,037 eligible patients, 41,433 (58%) were screened. Of these, 3463 (8.4%) had a clinically actionable positive screen. Follow-up evaluation was ordered in 31% of cases. A multivariable model demonstrated that inactive patient portal status, teenage patient age, patient race of "Unknown," and public insurance were associated with lower screening rates.

Implementing universal history-based sudden cardiac death risk screening in a pediatric primary care network exhibited an 8.4% positivity rate after clinician review, representing a large potential burden of cardiology referrals. Over half of eligible patients were screened, and follow-up evaluation was ordered in a minority of positive cases, signaling a gap in adoption/adherence. This implementation was associated with lower screening rates in certain disadvantaged populations.