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.