Abbatemarco, Justin, MS

Bennett, Courtney, DO

Matsumura, Martin E, MD

English

Lehigh Valley Health Network: LVHN Scholarly Works

Lehigh Valley Health NetworkLVHN Scholarly WorksDepartment of MedicineApplication of Pre-Participation ScreeningGuidelines to Novice Masters Endurance AthletesJustin Abbatemarco MSUSF MCOM- LVHN Campus, justin.abbatemarco@lvhn.orgCourtney Bennett DOLehigh Valley Health Network, Courtney_E.Bennett@lvhn.orgMartin E. Matsumura MDLehigh Valley Health Network, Martin_E.Matsumura@lvhn.orgFollow this and additional works at: http://scholarlyworks.lvhn.org/medicinePart of the Medical Sciences CommonsThis Poster is brought to you for free and open access by LVHN Scholarly Works. It has been accepted for inclusion in LVHN Scholarly Works by anauthorized administrator. For more information, please contact LibraryServices@lvhn.org.Published In/Presented AtAbbatemarco, J., Bennett, C., Matsumura, M. (2015, March 14). Application of Pre-Participation Screening Guidelines to Novice MastersEndurance Athletes. Poster presented at: American College of Cardiology Scientific Session and Expo, San Diego, CA.Lehigh Valley Health Network, Allentown, PennsylvaniaApplication of Pre-Participation Screening Guidelines to Novice Masters Endurance AthletesJustin R. Abbatemarco, Courtney Bennett DO, Martin E. Matsumura MDIntroduction:© 2015 Lehigh Valley Health NetworkFinancial Disclosures:The authors of this study have no personal financial disclosures.Methods:Results:Conclusion:•		The	explosive	growth	in	endurance	sports	has	given	rise	to	a	parallel	increase	in	the	number	of	older	athletes	competing	in	these	events	1-2•		Despite	this	increase	in	endurance	sports	there	are	no	uniform	guidelines	for	pre-participation	evaluation	(PPE)	in	athletes	>35	y/o	•		Furthermore,	little	is	known	regarding	the	use	of	existing	guidelines	in	decision	making	among	physicians•		The	MASTERS	Athletic	Study	is	a	longitudinal,	internet-based	survey	of	training	and	health	aspects	of	runners	>35	y/o•		In	the	present	study,	we	applied	2	currently	available	pre-participation	screening	guidelines	to	novice	runners	(<5	years	of	running	experience)	to	determine	who	would	be	“screened	in”	for	further	evaluation	and	testing•		Screening	guidelines	applied:  1  AHA/ACSM Pre-Participation Questionnaire (AAPQ)3   –  Recommends a pre-participation physician visit for all individuals who have prior cardiovascular conditions, symptoms or 2 or more risk factors  2  AHA Pre-Participation Guidelines for Masters Athletes (AHA Masters)4    –  Recommends pre-participation ECG for all individuals >40 y/o who are planning high-level athletic training/competition   –  Recommends pre-participation stress testing for men (>40 y/o) and women (>50 y/o) who have 1 risk factor,      •  All individuals >65 y/o•		We	assessed	athlete/physician	concordance	with	these	guidelines	(ie,	were	runners	that	“screen	in”	appropriately	referred	for	further	evaluation	and	were	those	that	“screen	out”	appropriately	cleared	to	begin	training?)	•		We	determined	the	independent	factors	that	were	associated	with	athlete/physician	decisions	for	further	PPE	and	testing•		Of	5850	total	survey	respondents,	1457	reported	<5	years	running	experience	CVD = cardiovascular disease, MI = myocardial infarctionTable 1. Participant Demographics and            Running HabitsCharacteristics(n=1457)  N %Age      Mean, y (range) 44.5 (35-86)Gender     Male 940 64.5     Female 517 35.5Risk Factors     Hypertension 167 11.5     Hypercholesterolemia 333 22.9     Diabetes meelitus 27 1.9     History MI 6 0.4     History of cardio- vascular dis. 34 2.3     Family history of CVD 577 39.6     Ever smoked 578 39.7Running habits     Have run marathon/ultramarathon 485 33.3     Participate in triathlons 230 15.8  Table 2. Completion of PPE and Testing Stratified by AAPQ Screening ResultsVariable AAPQ Screen IN*(n=614)AAPQ Screen OUT*(n=843)P-valuePre-participation doctor visit 316 (51.5) 335 (36.4 <0.001ECG 299 (48.7) 277 (30.1) <0.001Stress Test 136 (22.1) 97 (10.5) <0.001CAC/CIMT 62 (10.1) 27 (3.2) <0.001  Table 3. Completion of Pre-participation ECG and Stress Testing Stratified by AHA Masters 2001 Guidelines Screening Results Screen IN Screen OUT P-valueECG 458/1048 (43.7) 105/352 (29.8) <0.001Stress Test 122/495 (24.6) 111/962 (11.5) <0.001  *Values listed as n (%)AAPQ,AHA/American College of Sports Medicine Pre-participation Questionnaire, CAC = coronary artery calcium, CIMT = carotid intima media thickness, ECG = electrocardiogramECG = electrocardiogramFigure 1. Screening yield of AAPQ for recommendation of PPE by healthcare providerFigure 2. Screening yield of AHA Masters 2001 Guidelines for recommendation of PPE stress testingFigure 3. Forest plot illustrating independent predictors for PPE based on AAPQ simulation: Only athlete age was an independent predictor of PPE Figure 4. Forest plot illustrating independent predictors of stress testing based on AHA Masters 2001 Guidelines: Only athlete age and plan to complete a marathon/ distance event were independent predictors of stress testingAgeHypertensionDiabetesFamily History CADHyperlipidemiaSmokingRisk of Dying in RaceParticipate in Marathon0 1 2 31.071 (1.020, 1.123)0.929 (0.475, 1.815)0.293 (0.057, 1.514)1.269 (0.709, 2.270)1.485 (0.706, 3.12400.889 (0.520, 1.518)1.148 (0.857, 1.538)1.078 (0.625, 1.860)Odds ratio (95% CI)Odds RatioAgeHypertensionDiabetesFamily History CADHyperlipidemiaSmokingRisk of Dying in RaceParticipate in Marathon0 1 2 31.055 (1.026, 1.084)1.252 (0.795, 1.972)2.660 (0.769, 9.203)1.375 (0.915, 2.065)1.238 (0.783, 1.958)1.120 (0.742, 1.689)1.113 (0.900, 1.375)1.521 (1.009, 2.294)Odds ratio (95% CI)Odds Ratio843 (57.9%): No pre-participationevaluation indicated614 (42.1%): Pre-participationevaluation indicated962 (66.0%): Pre-participationstress testing not indicated495 (34.0%): Pre-participation stress testing•		Application	of	AAPQ	and	AHA	Masters	Screening	Guidelines	yielded	a	substantial	percentage	of	novice	runners	who	“screened	in”	for	further	cardiovascular	evaluation	and	testing	(more	than	1/3	for	each	screening	guideline)  –  Given the low risk of running-associated cardiovascular events, it seems unlikely that application of these guidelines are a cost-effective method to screen novice runners for further PPE and testing    •  Further study is required to confirm this concept •		Overall,	there	was	low	healthcare	provider	concordance	with	these	guidelines	  –  PPE was not performed in a substantial percentage of athletes who were “screened in” for further testing   –  Conversely, a substantial percentage of athletes who were “screened out” received further evaluation that may have been unnecessary according to the guidelines•		Athlete	age	was	a	strong	independent	factor	associated	with	PPE	and	testing,  –  Planning to complete a marathon or endurance event was also a strong predictor of pre-participation stress testing•		This	study	does	not	address	the	effectiveness	of	AAPQ	and	AHA	Masters	2001	Guidelines	to	identify	older	runners	who	warrant	further	evaluation	and	testing	in	an	accurate	and	cost-effective	manner	and	further	longitudinal	follow-up	will	be	required	to	address	this	questionReferences:1.  Running USA. Running usa’s annual marathon report. 2013.2.  Zingg M, Rust CA, Lepers R, Rosemann T, Knechtle B. Master runners dominate 24-h ultramarathons worldwide-a retrospective data analysis from 1998 to 2011. Extrem Physiol Med. 2013;2:21. 3.  Balady GJ, Chaitman B, Driscoll D, Foster C, Froelicher E, Gordon N, Pate R, Rippe J, Bazzarre T. Recommendations for cardiovascular screening, staffing, and emergency policies at health/fitness facilities. Circulation. 1998;97:2283-2293. 4.  Maron BJ, Araujo CG, Thompson PD, Fletcher GF, de Luna AB, Fleg JL, Pelliccia A, Balady GJ, Furlanello F, Van Camp SP, Elosua R, Chaitman BR, Bazzarre TL. Recommendations for preparticipation screening and the assessment of cardiovascular disease in masters athletes. Circulation. 2001;103:327-334. 

Application of Pre-Participation Screening Guidelines to Novice Masters Endurance Athletes

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Application of Pre-Participation Screening Guidelines to Novice Masters Endurance Athletes

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