Largest study shows cardiac screening in young people identifies hidden heart risk and saves lives

Published today in the Journal of the American College of Cardiology (JACC), the study is the largest of its kind. It analysed outcomes from more than 104,000 people aged 14 to 35 who underwent electrocardiogram (ECG) heart checks through Cardiac Risk in the Young’s (CRY) national screening programme between 2008 and 2018.

One in 300

Researchers found that one in 300 young people screened and evaluated were identified with heart conditions that could have fatal consequences if left unmonitored and untreated.

Over 40% of those diagnosed during the 10-year period went on to receive significant risk‑reducing interventions, including implantable defibrillators, pacemakers, ablation surgery or, in two cases, heart transplantation. The remaining cohort identified with heart issues were offered treatment pathways, including medication, monitoring and important lifestyle and exercise advice.

The ‘game-changing’ results of this important paper provide the most comprehensive overview to date of cardiac screening in the general population, showing the sensitivity of current testing protocols stands at an impressive 77% with a very low false positive rate of just 2.1%.

The results also highlight that a ‘one-off’ test is not always sufficient and that more regular screening is required to identify conditions. Over a six-year follow-up period after screening, 0.08% of the individuals who had a normal ECG result at the time of their screening were later diagnosed with conditions associated with sudden cardiac death or sudden cardiac arrest.

A need for repeat screening

Professor Michael Papadakis, Professor of Cardiology at City St George’s and study lead, said:

This study shows that cardiac screening can save lives. Across a decade of screening, we identified hundreds of young people with dangerous heart conditions who were able to receive treatment before tragedy struck. But it also highlights that a single screening is not enough. Some conditions develop later, and others are very difficult to detect early. So, if we want to further reduce sudden cardiac deaths in young people, we need to develop even stronger and even smarter prevention strategies.

Cardiac risk not limited to athletes

Although cardiac screening has historically focused elite athletes, this study found no significant difference in risk between athletes and non‑athletes. Only 9% of screened participants were competitive athletes, yet serious conditions were detected across the board.

The team say that this raises important questions about current UK screening policies, which generally focus on sport but not the general public.

Professor Sanjay Sharma, Professor of Cardiology at City St George’s and one of the world’s leading experts in sports cardiology and inherited cardiac conditions, said:

When we began this journey, few believed it would be possible to prevent sudden deaths in young people but today, the importance of our research is clear, and it points to a future in which many more young lives will be saved.

"It should never be forgotten that this seminal piece of work is only possible due to the exceptional and tireless fundraising efforts of bereaved families across the UK who somehow manage to see beyond their own grief to do all they can to prevent other families from going through a similar, devastating experience. Thank you."

Embedding AI to identify hidden clues

The City St George’s team is now expanding its research and expects to report outcomes from 300,000 screened individuals in the next two years. Future work will explore how artificial intelligence could support ECG interpretation – identifying clues that the naked eye cannot see.

Professor Michael Papadakis added:

AI has the potential to considerably enhance the power and accuracy of ECG as a screening tool to identify young individuals at risk of cardiac arrest, as well as massively upscaling a nationwide screening programme and significantly reducing the associated costs.

Preventing avoidable deaths

At a time when the UK’s National Screening Committee finds itself under scrutiny for its rejection of proposals to support the implementation of preventive screening programmes for other disease areas (e.g. prostate cancer), charity campaigners and bereaved families hope this new paper will bring further evidence and armoury to the ongoing battle for greater investment into the prevention of young sudden cardiac deaths, and greater access for young people to cardiac screening initiatives.