Public Health England hosts the UK National Screening Committee
Sudden Cardiac Death
Screening in 12 to 39 year olds
Dr Sunil Bhanot
Definition
Sudden Cardiac Death
• Death (unexpected sudden cardiac arrest) occurring within one hour of the
onset of symptoms in a young person without a previously recognised
cardiovascular abnormality
• It is usually precipitated by physical activity
• Causes
• Structural: Hypertrophic Cardiomyopathy
• Electrical abnormalities: Arrhythmia
• External causes: Blunt chest injury
2 Sudden Cardiac Death Screening in 12 to 39 year olds
Commissioning
• 2008 UK NSC recommended against Hypertrophic Cardiomyopathy
screening
• Rationale: Accuracy of testing
• High False Positives and False Negatives
• 2013 Present review commissioned
• Undertaken by Phil Wiffen (Oxford Systematic Review Services) and
Mike Clarke (University of Belfast)
• Wider scope exploring broad range of conditions associated with Sudden
Cardiac Death in young people
3 Sudden Cardiac Death Screening in 12 to 39 year olds
Document Development
• Literature search
• All research on Sudden Cardiac Death between 1974 and end of 2013
• Primary question
• Impact of screening in reducing incidence of Sudden Cardiac Death in 12
to 39 year olds
• Secondary questions
• Availability of screening tests and their accuracy
• National screening practices
• Evidence of benefits and harms
4 Sudden Cardiac Death Screening in 12 to 39 year olds
Review Findings• Important health issue but uncertainty over incidence
• Poorly understood conditions that lead to Sudden Cardiac Death
• No high quality evidence to guide clinicians advising patients on
management, treatment and lifestyle
• Test performance: No studies reporting on sensitivity and specificity.
• Little screening programme evidence
• Literature mostly on screening in young people participating in sport
• Screening evidence is not peer reviewed or has been questioned
• No direct evidence that screening reduces incidence of Sudden Cardiac
Death
5 Sudden Cardiac Death Screening in 12 to 39 year olds
Consultation• 3 month Consultation opened in November 2014
• Responses from:
• 3 families affected by Sudden Cardiac Death
• Personal submission from National Clinical Director for Heart Disease
• British Cardiovascular Society
• Royal College of Paediatrics and Child Health
• Cardiac Risk in the Young (CRY)
• Consultation responses acknowledged limited evidence around:
• effect of screening on preventing Sudden Cardiac Death
• management of people with risk factors
• Uncertainty of current strategy
• Not all stakeholders agreed with the recommendation
6 Sudden Cardiac Death Screening in 12 to 39 year olds
UK National Screening Committee
• Further literature consideration
sent in as part of consultation comments was considered by the external
reviewers and final recommendation brought to the UK NSC in May 2015.
• Recommendation
• The UK NSC does not recommend a systematic population screening
programme for Sudden Cardiac Death.
• There are serious limitations in the literature on fundamental issues
relating to the condition, test, intervention and cost-effectiveness of a
screening programme.
7 Sudden Cardiac Death Screening in 12 to 39 year olds
Recent News and Studies
• Van Brabandt et al. 2016 Harms and Benefits of Screening Young People to
Prevents Sudden Cardiac Death.
• 2016 National Collegiate Athletic Association (USA) consensus guidelines
• American College of Cardiology and American Heart Association do not
recommend routine, large scale ECGs.
• Recommend taking family history and physical examination.
8 Sudden Cardiac Death Screening in 12 to 39 year olds
What Might Screening Look Like?... Van Brabandt et al. 2016 Belgium Study
9 Sudden Cardiac Death Screening in 12 to 39 year olds
Infographic reproduced, with permission, from Van Brabandt et al. 2016 HTA study
of potential SCD screening in Belgium
References1. https://legacyscreening.phe.org.uk/suddencardiacdeath
2. Van Brabandt et al. 2016 , H. Desomer, A. Gerkens S. and Neyt, M (2016)
Harms and Benefits of Screening Young People to Prevents Sudden
Cardiac Death, BMJ, 2016;353:i1158
3. Infographic reproduced from Van Brabandt et al. 2016
https://kce.fgov.be/sites/default/files/page_documents/KCE_241Cs_sportscr
eening_Synthesis_0.pdf
10 Sudden Cardiac Death Screening in 12 to 39 year olds
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