Diagnostic yield and financial implications of a nationwide electrocardiographic screening programme to detect cardiac disease in the young

Author:

Dhutia Harshil12,Malhotra Aneil23,Finocchiaro Gherardo2,Parpia Sameer4,Bhatia Raghav2,D’Silva Andrew2,Gati Sabiha2ORCID,Mellor Greg2ORCID,Narain Rajay2,Chandra Navin2,Behr Elijah2,Tome Maite2ORCID,Papadakis Michael2,Sharma Sanjay2ORCID

Affiliation:

1. Department of Cardiology, Glenfield Hospital, University Hospitals of Leicester, Leicester, UK

2. Cardiology Clinical Academic Group, Molecular and Clinical Sciences Research Institute, St. George's, University of London University of London, UK

3. Division of Cardiovascular Sciences, University of Manchester and Manchester Foundation NHS Trust, Manchester, UK

4. Ontario Clinical Oncology Group, McMaster University, Hamilton, ON, Canada

Abstract

Abstract Aims There is limited information on the role of screening with electrocardiography (ECG) for identifying cardiovascular diseases associated with sudden cardiac death (SCD) in a non-select group of adolescents and young adults in the general population. Methods and results Between 2012 and 2014, 26 900 young individuals (aged 14–35 years) were prospectively evaluated with a health questionnaire and ECG. Individuals with abnormal results underwent secondary investigations, the costs of which were being based on the UK National Health Service tariffs. Six hundred and seventy-five (2.5%) individuals required further investigation for an abnormal health questionnaire, 2175 (8.1%) for an abnormal ECG, and 114 (0.5%) for both. Diseases associated with young SCD were identified in 88 (0.3%) individuals of which 15 (17%) were detected with the health questionnaire, 72 (81%) with ECG and 2 (2%) with both. Forty-nine (56%) of these individuals received medical intervention beyond lifestyle modification advice in the follow-up period of 24 months. The overall cost of the evaluation process was €97 per person screened, €17 834 per cardiovascular disease detected, and €29 588 per cardiovascular disease associated with SCD detected. Inclusion of ECG was associated with a 36% cost reduction per diagnosis of diseases associated with SCD compared with the health questionnaire alone. Conclusion The inclusion of an ECG to a health questionnaire is associated with a five-fold increase in the ability to detect disease associated with SCD in young individuals and is more cost effective for detecting serious disease compared with screening with a health questionnaire alone.

Funder

charity Cardiac Risk in the Young to study sudden cardiac death in the young

Publisher

Oxford University Press (OUP)

Subject

Physiology (medical),Cardiology and Cardiovascular Medicine

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