Family history of cardiovascular disease in athletes: 2 sports medicine clinics, 4 systems of preparticipation screening, 7 years of work. Is it time for a change?

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): IGA-internal grant agency Palacky University,Olomouc.

Searching for a positive family history (FH) of cardiovascular disease (CVD) or sudden cardiac death (SCD) is a standard part of preparticipation screening (PPS) of athletes. This is despite the fact that there is no evidence to support either a mortality or cost-effective benefit of this practice.

It is generally accepted that the use of a questionnaire method of family history investigation will expedite and refine the process of obtaining adequate responses required for the PPS.

There are a number of PPS systems currently in use around the world, of which four standardized PPS systems are very commonly used (AHA; 5thPPE; IOC = Lausanne Questionnaire; FIFA), each with its own questionnaire that is distinct from the other systems.

A positive finding of a family history of CVD/SCD in an athlete during PPS is an accepted indication for (sports) cardiology investigation. However, there is no evidence to define the scope of this examination and validate the mortality or cost-effective benefit of this practice.

1. To determine the number of athletes with positive FH in the entire cohort using questionnaires from the four PPS systems mentioned above.

2. Evaluate differences in frequency analysis of each questionnaire.

3. To identify question wording issues and to highlight overly "soft" criteria in each PPS system.

4. Propose optimization of FH data collection and follow-up.

Between 2015 and 6/2022, 14083 patients were screened at 2 centers. There were 13879 athletes with traceable FH (3768 females -27.1%), aged 14 (IQR 5) years.

180 athletes (1.3%) had positive FH according to at least one PPS system. The IOC system generated the fewest positive responses, followed by the AHA and FIFA, and the 5thPPE system clearly generated the most positive responses (by 80% compared to IOC). See Table 1. Clearly the "softest" question is the query about any heart disease/heart problems/ in 5thPPE, this alone is responsible for the majority of positive responses above the response levels of the other systems.

Investigating positive FH CVD/SCD is an established part of the athlete's PPS. There is up to 80% variation when using the 4 globally accepted PPS questionnaires. The lack of evidence for their use, as well as the lack of evidence for other cardiac retrospective investigations, coupled with their complexity and difficulty for patients to understand, is a challenge to research in this field.