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Community Cardiovascular Screening to Identify Middle School Children at Risk of Sudden Cardiac Death: The Houston Early Age Risk Testing and Screening (HEARTS) Study

John P Higgins

Purpose: Sudden cardiac arrest in school children is often associated with an underlying cardiac abnormality and can be triggered by athletic activity. We tested the feasibility and efficacy of an onsite four-point 15-minute preparticipation cardiac screening of school children to improve detection of cardiac abnormalities. Methods: Two hundred and fifty four sixth-grade students were screened at their schools for cardiac abnormalities by onsite focused history, focal cardiovascular physical exam, 12-lead electrocardiogram, and limited echocardiogram. Results: Subjects were primarily African American and Hispanic; 54.7% were girls. We identified 103 (40.6%) subjects with abnormalities on history and physical exam, 50 (19.7%) with hypertension, 80 (31.5%) with electrocardiographic abnormalities, and 32 (13.0%) with echocardiographic abnormalities. Based on these findings, 25 subjects (9.8%) were advised not to participate in rigorous exercise pending further evaluation. The ability to detect abnormalities increased 36.0% with addition of electrocardiograms and 40.0% with addition of echocardiograms. Conclusion: Our onsite four-point screening system is feasible and effective in detecting undiagnosed cardiac abnormalities and identifying false-positive results. Both athletic and non-athletic children had undiagnosed cardiac abnormalities, which suggests the utility of screening all schoolchildren for cardiac abnormalities.