Teresa Mago describes her son Zac as an honor student, a caretaker for his family and a fierce basketball player.
Zac got heart screenings in South Bend, Ind. in 2014 after his doctor thought he heard a heart murmur. The test showed he was fine. In 2018, the mother and son heard about a teenager dying from sudden cardiac arrest. But they thought Zac was in the clear.
鈥淎nd ironically, he and I talked about it,鈥� Mago said. 鈥淎nd we're like, 鈥楽o glad we don't have to worry about that with you, because you had had a heart screening.鈥欌��
Electrocardiograms (EKG) and echocardiograms (echo) are two key screening tests to monitor a person鈥檚 cardiovascular health. An EKG is a machine that maps out the electrical rhythm of the heart to check for any abnormalities, while an echocardiogram is a live-imaging test that doctors use to produce an image of the heart and its valves.
EKGs are than physical exams at capturing heart conditions. But the screening is only a snippet in time. It doesn鈥檛 account for when people go in and out of irregular heart rhythms. And they can sometimes incorrectly diagnose people.
Some medical professionals recommend kids get screened annually after detecting a potential heart abnormality. But Teresa said Zac鈥檚 cardiologist didn鈥檛 tell them that.
Exactly a week before his 18th birthday, Zac鈥檚 heart stopped pumping blood. He went into cardiac arrest in July 2018 due to an enlarged heart. His mom thinks his death could have been prevented.
鈥淗ad he had a screening two years later, we might have seen something,鈥� Mago said. 鈥淎nd then maybe even screened again, two years later, we definitely would have caught that.鈥�
Yet, medical professionals have spent more than 40 years debating whether the benefits of mandatory heart screenings for children outweigh their drawbacks.
Should the United States mandate heart screenings?
experience a sudden cardiac arrest annually. Many people say it鈥檚 a rare occurrence. But when it happens, it鈥檚 .
from sudden cardiac arrest don鈥檛 show symptoms.
The American Heart Association hopes to improve cardiac arrest outcomes by 2030. One of their goals is to increase the rate of bystander CPR response from 40% to over 50%, especially in communities with diverse racial demographics and low economic status.
Still, the doesn鈥檛 recommend mandating heart screenings. They suggest giving a doctor your family history, have them listen to the heart with a stethoscope and complete a physical.
Some medical professionals like cardiologist Preetham Jetty with Community Health Network say that may not be enough for everyone.
鈥淐an history and physical exam find everyone who's going to have a cardiac event? The answer is no, you will miss some,鈥� Jetty said. 鈥淎nd that's where EKGs and ultrasounds can add some value.鈥�
But an EKG and an echo can cost thousands of dollars out of pocket. That鈥檚 why many advocates and parents across the country, like Teresa Mago, now host heart screenings at reduced or no cost after losing a child to sudden cardiac arrest.
Mago said the , which provides heart screenings and helps organizations get automated external defibrillators, finds a heart abnormality in 1 in every 300 kids they test.
Ashley Williams鈥� nonprofit, , provides echo and EKG screenings to people ages 10 to 25 for $99 with options for financial assistance. This year, she said they found about 120 abnormalities in 1,500 children tested.
鈥淪ometimes you have parents driving for hours to come here for a 15 minute test,鈥� Williams said. 鈥淚t鈥檚 still a hindrance for a lot of parents who don鈥檛 have a free eight hours to spend back and forth for a 15 minute test when they're hearing on the news that something's rare.鈥�
Are heart screening mandates actually helpful?
Even without the barriers of cost and access, some medical professionals are against mandating heart screening for children. They say the benefits do not outweigh the risks of misdiagnosis.
鈥淭his is a natural human reaction, to want to do something to make your child's death more meaningful,鈥� said Ben Levine, a cardiologist at the University of Texas Southwestern Medical Center. 鈥淭hey want to help. But they don't necessarily understand or think through all the downstream consequences.鈥�
Levine said there isn鈥檛 enough data to show that getting a heart screening prevents death. According to studies, EKGs can incorrectly diagnose heart problems in as much as . Levine said inaccuracies from these tests can lead to families spending thousands of dollars in unnecessary medical bills and unneeded surgeries with potential complications.
鈥淭he problem is, A, [the] screening is not perfect,鈥� Levine said, 鈥淏, it causes a lot of problems and may in certain cases hurt people rather than help them and the majority of people who are going to die or have a cardiac arrest are those who had normal screening to begin with.鈥�
While research in Italy suggested that mandating heart screenings for all athletes was behind in sudden cardiac arrest deaths, studies in other countries did not yield similar results. And the Italian team was accused of for an independent review.
Pediatric cardiologist Kristin Burns with the National Heart, Lung, Blood Institute said Italy is able to mandate screenings because their population is a fraction of the U.S., and Italy also trains more types of medical professionals to read screenings. But mandating heart screenings in the U.S. could also add a burden to the strained health care system as cardiologists are in short supply due to a workforce shortage.
鈥淚n rural areas, there鈥檚 far fewer [pediatric cardiologists] nearby or available to be able to provide screenings, or provide the follow up to the screening, in a timely fashion,鈥� Burns said.
No states currently require students to get a heart screening.
Levine spent years to mandate heart screenings for kids. Florida has also failed to pass similar state legislation, but now require students to have a heart screening in order to participate in athletics. Lawmakers in New York are . But Levine said that would be a mistake.
鈥淭hey will hurt more people than they will help,鈥� Levine said.
The question of whether EKGs save lives could be answered through a randomized controlled trial, he said, but there hasn鈥檛 been a big enough study and the data is spotty.
鈥淭he big problem for us was that it's almost impossible to track outcomes in the United States,鈥� Levine said. 鈥淭hat's what makes it so difficult to study. There's no mandatory reporting system for sudden cardiac arrest.鈥�
Last fall, the U.S. Centers for Disease Control and Prevention announced that the 鈥� the only national organization that connects out-of-hospital cardiac arrest data with hospital outcomes 鈥� will receive $23.85 million in grant funding over the next five years. The additional funds will improve data collection and analysis. CARES currently works with 33 states and 51 additional communities, but hopes to expand across the entire country to better understand how to improve communities' responses to cardiac arrest victims.
One thing the medical community agrees on is that training people on how to do CPR, or AEDs, and having an emergency action plan can help save lives.
Contact WFYI鈥檚 health reporter Elizabeth Gabriel at egabriel@wfyi.org.
Side Effects Public Media is a health reporting collaboration based at WFYI in Indianapolis. We partner with NPR stations across the Midwest and surrounding areas 鈥� including KBIA and KCUR in Missouri, Iowa Public Radio, Ideastream in Ohio and WFPL in Kentucky.
This reporting is supported by a grant from the 2023 Data Fellowship.
Copyright 2024 Side Effects Public Media. To see more, visit . 9(MDA3NTgyODY4MDEzMDcxMjU4NjBlODYwNg001))
