In Ontario, Canada the billing price for an ECG is $14.00. The cost of accessing health care services is different in every country as is the ability of each system to deliver services. However the real cost of ECG is minuscule relative to the information it provides and the ease with which that information can be acquired. Virtually everyone in the health care system from Paramedics to RN's to GP's to Cardiologists are trained (and often equipped) to acquire an ECG. Reading and interpreting ECG's requires special skills and training however many health care professionals are very good at spotting suspicious ECG's that should be referred to a specialist. The current generation of ECG monitors are programmed with excellent algorithms that are more accurate than many people at spotting trouble.
When people set out to do a repetitive task they design efficiencies into the system and continually refine their methods while monitoring for quality assurance and quality improvement. I submit that within two years a digital system that acquires an ECG for every Grade 9 student in Ontario and attaches it to their permanent health record could be in operation and the cost per child would be less than $7.00.
This long preamble is my way of saying we should acquire an ECG for every teenager in Canada or your Country here. My personal interest in ECG Screening is that I advocate for individuals and families living with an Inherited Heart Rhythm Disorder; those that have a diagnosis and more importantly those that are unaware that they are living with a potentially lethal disease. A complete patient and family history along with an ECG provides an excellent starting point for identifying at-risk individuals and families. Papers published on various screening programs that have been piloted around the world suggest that somewhere between 1 in 120/150 young people screened will be recommended for follow-up with a cardiologist. I have seen no published articles that follow these individuals however given that most heart rhythm disorders are genetic the yield for individuals with a definitive diagnosis as result of screening will be multiplied as affected family members are identified. In addition to screening for arrhythmia an even greater benefit to the patient and the health care system will come from having a baseline ECG attached to every patients permanent file, which Doctors can and will refer to throughout that patients life.
All children should be screened. So much of the conversation around screening speaks to athletes. Genetic disease does not recognize athletic ability. Only one third of young people killed by an Inherited Heart Rhythm Disorder were engaged in physical activity preceding sudden death. Intense physical activity is one known trigger for cardiac arrest in patients with an inherited heart rhythm disorder, as is auditory startle, from an alarm clock perhaps, as is emotional distress, such as a pending Math exam. When a young athlete dies in a filled to capacity sporting venue there is going to be a media storm. For every athlete that dies during a game there are two or more children that die outside of the media spotlight, many, perhaps most, are non-athletes. The prevalence of genetic heart disease is spread equally across children of all different abilities and capabilities. Every child deserves equal attention.
All medical screening program generates a small percentage of false positives. An ECG that requires follow-up is not a positive test it is an ECG that requires follow-up. There is no diagnosis until the Cardiologist has completed their work and made a determination. An ECG that does not require follow-up is not a negative test, it is simply an ECG that is not suggestive of heart disease or defect.
In the world of "Do No Harm" the harm is done by not screening.
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