Bill would expand athletes' heart testing

B.J. Giannone, 18, climbed out of a pool and collapsed of a heart attack on Jan. 31, 2011, moments after finishing a relay race with his St. Peter's Prep swim team in Jersey City, N.J. Such sudden deaths claim more than 100 student athletes in the heat of competition each year in the United States.

Legislation to be introduced in Trenton this week will aim to improve screening of children and teenagers to detect heart abnormalities before the children participate in activities that might be life-threatening.

Sen. Fred. H. Madden (D., Gloucester) said that on Thursday he would introduce the first of several bills to follow recommendations of the New Jersey Student Athlete Cardiac Screening Task Force, established in 2010 by legislation that Madden also sponsored. The task force report, made public in April, does not recommend electrocardiograms for all as part of the routine physicals required before students participate in school sports. Rather, it advocates doing a more thorough job of obtaining family medical histories to flag genetic heart defects and providing specialized training for the physicians and advanced-practice nurses who conduct sports physicals so they are vigilant for possible cardiac problems.

Student athletes whose family histories and medical exams place them at greater risk would then become candidates for electrocardiograms. The report also recommends requiring health-insurance plans to cover annual sports physicals focused on cardiac and musculoskeletal health. It also recommends having automatic external defibrillators close at hand during practice and competition and training coaches, teachers, athletes, and others involved in school sports how to use them.

The task force was chaired by Stephen Rice, president of the American Academy of Pediatrics, New Jersey chapter, a specialist in pediatric sports medicine. Rice said the task force decided it was not now feasible to recommend EKGs for all student athletes, both because of the cost and because the test would likely generate an excessive number of false positives.

"However," he said, "advances are being developed that are sharpening up the criteria for normal and abnormal [readings] on the EKG. It may become less expensive and produce fewer false positives, and we may be revisiting the issue" of whether to make the EKG a standard feature of the school sports physical.

Madden said his legislation would require additional training in cardiac assessment for health-care professionals who screen student athletes. "We can improve the screening, and do a better job of identifying at-risk athletes, and then do EKGs" on those who are at risk, Madden said. "The task force recommendations will make sure we have a stronger system in New Jersey for the way we screen our student athletes. Coupling that with the insurance companies' paying for the cost of additional screening is critical."

EKGs for student athletes before they participate in sports have been conducted since 2007 by the Matthew J. Morahan III Health Assessment Center for Athletes at the Barnabas Health ambulatory care center in Livingston. Medical director Donald Putnam said the center had screened 1,500 student athletes so far and identified a handful of heart abnormalities that he said were not life-threatening. He estimated that between 1 in 100,000 and 1 in 200,000 people have the kind of heart defect that would disqualify them from sports.

"We're talking about trying to find a needle in a haystack," he said. Nevertheless, he advocates performing baseline EKGs on all children as they move from primary to middle school. "If we can save one kid in the state of New Jersey, I feel that we have done the right thing. We should not have young kids dying on athletic fields in this day and age with what we have available to us."

Rice said, "If we get a good family history and do a good physical, that will help us identify the people who really do need an EKG." Parents need to understand the importance of providing a thorough family history when filling out forms for sports participation, Rice said. "That is how a lot of tragedy that could be prevented."

Rice added that hypertrophic cardiomyopathy, a genetic disorder that produces abnormal thickening of the heart muscle, was the number-one cause of sudden death in athletes. There have been cases in which teenagers have died suddenly while playing sports, and "when you actually sit down with the family afterward, you find out that a cousin or an uncle also died suddenly. Getting a complete family history is very, very important."

Read more of Beth Fitzgerald's health stories on www.njspotlight.com