What is the most appropriate age for the first cardiac screening of athletes?

Cardiac screening of elite athletes is common in many countries, and is recommended by numerous international guidelines. Many sporting organisations require screening prior to participation in peak competitions such as World Championships and Olympic Games. However, there are very few consistent guidelines on the age at which to start. Our review found that the total rate of sudden cardiac arrest or death (SCA/D) is very low between the ages of 8–11 years (less than 1/100,000/year), increasing to 1–2/100,000/year in both elite athletes and community athletes aged 12–15 years and then steadily increases with age. The conditions associated with SCA/D in paediatric athletes and young adult athletes are very similar with some evidence that death from coronary artery anomalies occurs more frequently in athletes 10–14 years old.In some countries, a broad screening program is conducted for community athletes to reduce cardiac risk in the entire population. In other countries, there is no systematic program and individual sports determine their own policy for screening athletes, usually limited to the elite level. The decision when to begin a screening program involves a complex interplay between medical requirements such as natural history of disease conferring risk for SCD, medical existing practices in a country, the rules of different leagues and programs, the age of entry into an elite program, the underlying risk of the population (which may vary between countries) and the resources available. Given the incidence of SCA/D in young people, cardiac screening should commence no earlier than 12 years of age (not later than 16 years of age). The risk of SCA/D increases with age, therefore, starting a program at any point after age 12 has added value. Importantly, anyone with concerning symptoms or family history should see a physician irrespective of age. Finally, no screening program can capture all abnormalities, and it is essential for organisations to implement a cardiac emergency plan including training on recognition and response to SCA and prompt access to resuscitation facilities, including defibrillators.