EACH YEAR, about 100 young athletes around the country -- and about two in Massachusetts -- die suddenly during games or practices of undiagnosed heart defects. Most of these conditions could be detected, and the deaths averted, through use of an electrocardiogram as part of the student’s standard pre-participation physical. Since two recent studies have shown that such testing is both effective and affordable, the state should take steps to make it routine.
Doing so would require the Legislature to impose two mandates. One would oblige all school districts and colleges to make such testing a condition of participation in athletics. The other mandate would be on health insurers: all public and private plans in the state would have to cover electrocardiograms for children, free of any deductibles or copayments. This would ensure that the testing is not a barrier to sports for low-income students. At the start, such testing might tax the capacity of cardiologists trained in treating adolescent conditions, but the statewide mandate would likely spur pediatric or adult cardiologists to broaden their expertise.
In a study of 510 Harvard University athletes, echocardiograms and electrocardiograms found 11 with underlying heart defects - three so severe the athletes’ participation was restricted. Regular physicals and medical histories turned up five of those 11 cases, but missed six. The downside was that the testing turned up 83 false positives requiring further testing. Still, another study found that the total cost of the testing per athlete would be $89 and some doctors believe that the number of false positives can be reduced significantly through better testing methods. Italy has made heart-testing of young athletes standard for almost 30 years, and the European Society of Cardiology and the International Olympic Committee are both recommending electrocardiograms for athletes.
State-imposed mandates on insurers are often held up as one of the drivers in the state’s high cost of health care. But this mandate is relatively limited and inexpensive. Plus, it’s hard to measure in dollars the agony of families who lose children, or of the productive lives cut short. If a health-insurance mandate can keep two young lives from ending without warning on a basketball court or football field each year, it would be worth society’s investment.
