Pre-participation screening for athletes and the role of advanced practice providers

• The AHA/ACC “do not support national mandatory screening ECGs of athletes, because the logistics, manpower, financial and resource considerations make such a program inapplicable to the US”. In addition they cite that there is a lack of appropriately trained and knowledgeable physicians available to perform pre-participation examinations and interpret an ECG.
• Currently, performing the PPE with ECG interpretation is within advanced practice providers (Nurse Practitioners and Physician Assistants) scope of practice. Utilizing this workforce could significantly increase access to pre-participation examinations for athletes and communities.
• The development of a national 12-lead ECG interpretation education and certification program is needed, as well as the creation of standard primary care provider screening tools and mass screening protocols for PPE that include screening ECGs for targeted athlete populations who are at high risk for SCD.

Pre-participation screening of athletes for underlying cardiovascular disease is recommended by the AHA/ACC. However, vigorous debate continues as to whether the ECG should be used as part of a broad-based screening program. The AHA/ACC “do not support national mandatory screening ECGs of athletes, because the logistics, manpower, financial and resource considerations make such a program inapplicable to US”. In an effort to address these impediments and to increase access for communities, we explore the use of advanced practice providers (Nurse Practitioners and Physician Assistants) in providing pre-participation screening to athletes with ECG interpretation. In the current healthcare environment with limited primary care resources, advanced practice providers are an important new element in improving access to care. Pre-participation screening with ECG interpretation is currently within an advanced practice provider's scope of practice. Emerging data shows that advanced practice providers perform care that is within acceptable patient care standards, safely, and cost effectively, compared to physician counterparts. To further improve pre-participation screening, a national education and certification program on 12-lead ECG interpretation is needed. Standardized screening tools and mass screening protocols that include screening ECGs for targeted athlete populations who are at high risk for SCD are needed. These recommendations are aimed at addressing some of the barriers raised by the AHA/ACC group to pre-participation screening with ECG.