A 12-PART screening can reduce the number of sudden deaths from unsuspected cardiovascular (CV) maladies among high school and college athletes, an American Heart Association (AHA) panel says. But the screening should not include routine ECGs, which the panel called impractical, expensive, and too unreliable.

CV deaths among the country’s 5.5 million young competitive athletes “are more common than previously thought and represent a substantive public-health problem,” says Barry J. Maron, MD, who chaired the AHA writing group. Sudden deaths occur at a rate of approximately one per 200,000 annually among teenagers, most often in football and basketball.

The total estimated cost of routine ECGs for competitive athletes of all ages, along with the follow-up required for abnormal findings, would be more than $2 billion a year, says Dr. Maron, who works at the Minneapolis Heart Institute Foundation. ECGs also yield many false-positive results—as high as 25%, the AHA panel said. Citing other limitations, such as a lack of medical resources for performing and reading the results, the panel decided against routine testing.

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The new guidelines, issued as a “scientific statement,” update those from 1996 but make no major changes. They call for a 12-point screening that combines medical history and a physical examination, with the goal of finding signs of an unsuspected or unreported CV defect, such as Marfan syndrome, heart murmur, hypertension, or aortic coarctation. If parents verify the reporting of a cardiac problem, the NP or PA should refer the youngster for further testing.