Two years ago, around 9 at night, my 18-year-old son came home after studying for a test. Luckily I was there to greet him. We talked briefly about the full moon, and then he gasped and collapsed. His heart had stopped. Another son heard my screaming and got my wife to call 911. Another started CPR. Then early responders, ambulance, intensive-care unit, induced coma, feeding tube, batteries of tests, neurologists, physical therapists, a defibrillator installed. Twenty days later he walked out of the hospital. The total bill was over $1 million, nearly all paid by insurance.
We were fortunate. According to the American Heart Association, the fatality rate from sudden cardiac arrest is 90%, and over 50% even if someone is nearby to administer CPR. My son is now a sophomore in the Big Ten and loving life.
As you can imagine, my family now supports and volunteers for heart screenings done at area high schools. Screen Across America’s website shows the location of 60-plus organizations that provide screenings for students, in addition to instruction on how to do CPR and use portable defibrillators (though less than 1% of schools have them). In 2016, the American Heart Association estimates, more than 350,000 people in the U.S. experienced out-of-hospital cardiac arrest. That’s probably low; cardiac arrest while driving is an elusive statistic in fatal car accidents.
These volunteer-run free screenings, which include a 12-lead electrocardiogram, cost about $13,000 for 750 students, or less than $20 each. These screenings find that about 1% of young people have abnormal heart conditions—cardiomyopathy, Long QT syndrome and other heart arrhythmia problems. Early detection saves lives.
At the last screening I attended, I kept asking myself: Why do volunteer organizations have to do this? Why not schools? Or pediatricians? Why isn’t it mandatory?
A physical for clearance to play high-school sports involved a blood-pressure check, sticking out your tongue and saying ahh, and maybe a bump on the knee with that little rubber hammer. But no EKG. At under 20 bucks a pop, why not?
The NCAA doesn’t require EKGs for collegiate athletes either. That borders on negligence. Why isn’t an EKG part of every physical? The reason, it turns out, is that EKGs have been notoriously bad predictors, especially for the young. Upward of 25% of tests flag problems that don’t actually exist—false positives. Finding the 1% with real problems means expensive and emotionally distressing testing for the other 24%. Follow-up echocardiograms (ultrasound heart scans) and stress tests, let alone MRIs and CT scans, can run thousands of dollars. So doctors don’t do them.
That’s health care today—early detection often loses to the old “wait until they get sick and then we’ll treat ’em” regime. For 90% of cardiac arrests, treatment is not an option. And there are plenty of other notoriously high false-positive tests: mammograms, colonoscopies, and especially prostate-specific antigen tests.
But technology now exists to solve the false-positive problem. Recognizing that the young have different heart signatures than the general population, a group of leading pediatricians and sports doctors from around the world came up with the Seattle Criteria as a way to pinpoint heart abnormalities. It then got coded into an algorithm, a filter that looked for specific patterns that statistically indicated real, not false, positives. A $2,500 battery-operated 12-lead EKG from a company named Cardiac Insight is connected via Bluetooth to a laptop that electronically analyzes your heart rhythms and runs them through the Seattle Criteria algorithm.
There is even a newer algorithm known as the Refined Criteria, which also reduces the number of false positives in athletes. These algorithms improve over time with more screening data matched with real health outcomes. Instead of 20% to 25%, we could see false positives dropping to below 3%, according to recent research. That’s industry-changing. Smartphone-enabled EKG devices will also hit the market. Couple that with a $7,000 portable echocardiogram device from Philips that hooks to a tablet, and you’ve got a process more accurate than most cardiologists because it’s data-driven.
Until recently, prompted by the 1912 Titanic disaster, swimming tests were required at many universities. It’s time to make an EKG test part of a standard physical for sports and even college admissions. Brian Hainline became the NCAA’s chief medical officer in 2012. He initially pushed for heart screening but quickly backed off, telling the American Heart Association News in 2015: “At this point in time, it doesn’t make sense for us to recommend [EKG] screening.” Of course not, false positives were too expensive. But not anymore.
So what will it take? My guess is we are one lawsuit away from the NCAA implementing mandatory screening. Just run the numbers. There are close to half a million student-athletes at U.S. colleges. Even a 10% false-positive rate means 50,000 would need follow-on tests at around $2,000. That’s a total cost of $100 million, at least. But with a 2% false-positive rate, we’re talking $10 million for further testing. One juicy lawsuit all of a sudden justifies a wide screening. Like it or not, money talks. Next up would be screening the four million students who enter American high schools each fall.
While we’re at it, why not launch a nationwide initiative for low false-positive cancer screenings? No dramatic “moonshot,” just real science. The way to save lives is to catch disease early, before treatment is expensive, financially and emotionally. I think about this every time I see a full moon.