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

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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• Screening evidence is not peer reviewed or has been questioned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

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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.

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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.

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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