The medical value and cost-effectiveness of an exercise test for sport preparticipation evaluation in asymptomatic middle-aged white male and female athletes

Laurent Chevalier , Gaëlle Kervio (1) , Stephane Doutreleau , Jean-Philippe Mathieu , Jean-Michel Guy , Aude Mignot , Luc Corneloup , François Passard , Thierry Laporte , Aude Girard-Girod , Olivier Hennebert , Philippe Bernadet , Marie-Pierre Vincent-Chevalier , Laurent Gencel , François Carré (2, 3)

1 CIC-IT Rennes
2 LTSI - Laboratoire Traitement du Signal et de l'Image
3 CHU Pontchaillou [Rennes]

BACKGROUND: Cardiovascular events related to high-intensity sport practice are rare but dramatic. Coronary artery disease (CAD) is the leading cause of these events after the age of 35 years. The value of a maximal exercise test (ET) for detection of athletes at risk remains a matter of debate. AIM: The aim of this prospective multicentre study was to clarify the medical value and cost-effectiveness of an ET in middle-aged white asymptomatic athletes who participate in high-intensity sport. METHODS: All athletes had a physical examination, assessment of cardiovascular risk factors, a resting electrocardiogram and an ET. In case of abnormal ET, complementary cardiovascular evaluation was performed, when requested, to detect potential cardiovascular disease. RESULTS: 1361 asymptomatic athletes (mean age 50.4±9.6 years; mean training 5.1±3.2h/week; 10.4% women) with a normal resting electrocardiogram and without cardiovascular disease were consecutively included. An abnormal ET was reported in 144 subjects (94% men); this was positively related to the subject's age and cardiovascular risk level. Cardiac arrhythmias (48%) and CAD symptoms (33.3%) were mainly reported. Cardiovascular disease was confirmed in 24 cases (1.7% from the whole population; 16.7% from those with an abnormal ET) - mainly CAD (n=12) and arterial hypertension (n=8). Seventy athletes presented significant unexplained arrhythmias. The cost was approximately €8450 for every confirmed case of cardiovascular disease. CONCLUSIONS: In this multicentre study in middle-aged athletes, a systematic ET was abnormal in 10.6% of cases. About 2% of subjects had cardiovascular disease, mainly arrhythmias and CAD. From these results, it seems that in a trained population aged >35 years, ET should be targeted at men with at least two cardiovascular risk factors, with acceptable cost-effectiveness.

Keywords: Humans; Male; Middle Aged; Middle-aged athletes; Patient Selection; Predictive Value of Tests; Prognosis; Prospective Studies; Risk Assessment; Risk Factors; Sportifs d’âge moyen; Sport preparticipation cardiovascular screening; Exercise Test; Epreuve d’effort; Electrocardiography; Female; France; Health Care Costs; Adult; Aged; Arrhythmias; Cardiac; Asymptomatic Diseases; athletes; Blood Pressure; Coronary Artery Disease; Cost-Benefit Analysis; Cost-effectiveness; Coût efficacité; Death; Sudden; Dépistage cardiovasculaire pré-participation; Heart Rate

Domains: Life Sciences [q-bio]; Bioengineering

Laurent Chevalier, Gaëlle Kervio, Stephane Doutreleau, Jean-Philippe Mathieu, Jean-Michel Guy, et al.. The medical value and cost-effectiveness of an exercise test for sport preparticipation evaluation in asymptomatic middle-aged white male and female athletes. Archives of cardiovascular diseases, 2017, 110 (3), pp.149-156. ⟨10.1016/j.acvd.2016.06.001⟩. ⟨hal-01502237⟩