Presentation from the UK NSC conference in December 2016 about the recommendation on sudden cardiac death screening in 12 to 39 year olds.

1. Public Health England hosts the UK National Screening Committee
Sudden Cardiac Death
Screening in 12 to 39 year olds
Dr Sunil Bhanot

2. Definition
Sudden Cardiac Death
• Death (unexpected sudden cardiac arrest) occurring within one hour of the
onset of symptoms in a young person without a previously recognised
cardiovascular abnormality
• It is usually precipitated by physical activity
• Causes
• Structural: Hypertrophic Cardiomyopathy
• Electrical abnormalities: Arrhythmia
• External causes: Blunt chest injury
2 Sudden Cardiac Death Screening in 12 to 39 year olds

3. Commissioning
• 2008 UK NSC recommended against Hypertrophic Cardiomyopathy
screening
• Rationale: Accuracy of testing
• High False Positives and False Negatives
• 2013 Present review commissioned
• Undertaken by Phil Wiffen (Oxford Systematic Review Services) and
Mike Clarke (University of Belfast)
• Wider scope exploring broad range of conditions associated with Sudden
Cardiac Death in young people
3 Sudden Cardiac Death Screening in 12 to 39 year olds

4. Document Development
• Literature search
• All research on Sudden Cardiac Death between 1974 and end of 2013
• Primary question
• Impact of screening in reducing incidence of Sudden Cardiac Death in 12
to 39 year olds
• Secondary questions
• Availability of screening tests and their accuracy
• National screening practices
• Evidence of benefits and harms
4 Sudden Cardiac Death Screening in 12 to 39 year olds

5. Review Findings
• Important health issue but uncertainty over incidence
• Poorly understood conditions that lead to Sudden Cardiac Death
• No high quality evidence to guide clinicians advising patients on
management, treatment and lifestyle
• Test performance: No studies reporting on sensitivity and specificity.
• Little screening programme evidence
• Literature mostly on screening in young people participating in sport
• Screening evidence is not peer reviewed or has been questioned
• No direct evidence that screening reduces incidence of Sudden Cardiac
Death
5 Sudden Cardiac Death Screening in 12 to 39 year olds

6. Consultation
• 3 month Consultation opened in November 2014
• Responses from:
• 3 families affected by Sudden Cardiac Death
• Personal submission from National Clinical Director for Heart Disease
• British Cardiovascular Society
• Royal College of Paediatrics and Child Health
• Cardiac Risk in the Young (CRY)
• Consultation responses acknowledged limited evidence around:
• effect of screening on preventing Sudden Cardiac Death
• management of people with risk factors
• Uncertainty of current strategy
• Not all stakeholders agreed with the recommendation
6 Sudden Cardiac Death Screening in 12 to 39 year olds

7. UK National Screening Committee
• Further literature consideration
sent in as part of consultation comments was considered by the external
reviewers and final recommendation brought to the UK NSC in May 2015.
• Recommendation
• The UK NSC does not recommend a systematic population screening
programme for Sudden Cardiac Death.
• There are serious limitations in the literature on fundamental issues
relating to the condition, test, intervention and cost-effectiveness of a
screening programme.
7 Sudden Cardiac Death Screening in 12 to 39 year olds

8. Recent News and Studies
• Van Brabandt et al. 2016 Harms and Benefits of Screening Young People to
Prevents Sudden Cardiac Death.
• 2016 National Collegiate Athletic Association (USA) consensus guidelines
• American College of Cardiology and American Heart Association do not
recommend routine, large scale ECGs.
• Recommend taking family history and physical examination.
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9. What Might Screening Look Like?...
Van Brabandt et al. 2016 Belgium Study
9 Sudden Cardiac Death Screening in 12 to 39 year olds
Infographic reproduced, with permission, from Van Brabandt et al. 2016 HTA study
of potential SCD screening in Belgium

10. References
1. https://legacyscreening.phe.org.uk/suddencardiacdeath
2. Van Brabandt et al. 2016 , H. Desomer, A. Gerkens S. and Neyt, M (2016)
Harms and Benefits of Screening Young People to Prevents Sudden
Cardiac Death, BMJ, 2016;353:i1158
3. Infographic reproduced from Van Brabandt et al. 2016
https://kce.fgov.be/sites/default/files/page_documents/KCE_241Cs_sportscr
eening_Synthesis_0.pdf
10 Sudden Cardiac Death Screening in 12 to 39 year olds