AAP: All Youth Should Be Screened for Cardiac Risk

The American Academy of Pediatrics has updated their policy on cardiac risk screening in all children.

The recommendations are an update to the group’s 2012 policy statement, in an effort to better equip primary care providers and pediatricians with the necessary knowledge to accurately screen, evaluate, and manage the risk of both sudden cardiac arrest (SCA) and sudden cardiac death (SCD) in youth.

All children, regardless of athletic status, should be screened for conditions, such as channelopathies or cardiomyopathies, that may lead to adverse cardiac outcomes. Screening should be completed at least every 3 years, during the preparticipation physical evaluation, or upon entry into middle or high school.

To guide health care providers in properly assessing youth for risk of SCA/SCD, the policy outlines several questions to include during routine care:

• Have you ever fainted, passed out or had an unexplained seizure suddenly and without warning, especially during exercise or in response to sudden loud noises such as doorbells, alarm clocks and ringing telephones?
• Have you ever had exercise-related chest pain or shortness of breath?
• Has anyone in your immediate family (parents, grandparents, siblings) or other more distant relatives (aunts, uncles, cousins) died of heart problems or had an unexpected sudden death before age 50? This would include unexpected drownings, unexplained car accidents in which the relative was driving or sudden infant death syndrome.
• Are you related to anyone with hypertrophic cardiomyopathy or hypertrophic obstructive cardiomyopathy, Marfan syndrome, arrhythmogenic right ventricular cardiomyopathy, long QT syndrome, Brugada syndrome or catecholminergic polymorphic ventricular tachycardia, or anyone younger than 50 years with a pacemaker or implantable defibrillator?

In addition, the policy outlines secondary prevention measures including emergency response plans for schools, emphasis on advocacy by the primary care provider for cardiopulmonary resuscitation (CPR) and automated external defibrillator training, and guidance for after an incidence of cardiac arrest or death.

“The strategy put forth in this policy statement emphasizes the importance of sudden death awareness and prevention that is inclusive of all young people regardless of athletic status,” the authors concluded. “The emphasis shifts from focusing on a single group to expanding the primary and secondary prevention concepts to a broader group who may achieve similar benefits.”

—Leigh Precopio

Reference:

Erickson CC, Salerno JC, Berger S, et al. Sudden death in the young: information for the primary care provider. Pediatrics. Published online June 21, 2021. https://pediatrics.aappublications.org/content/early/2021/06/18/peds.2021-052044