Comprehensive heart screening for all recruits
Posted: Tue Jun 17, 2008 7:03 am
Should more comprehensive heart screening be done for all new recruits?
Two young precious sons of Singapore died while undergoing NS training recently. Naturally, parents are concerned as for many they have only one son.
Should more comprehensive heart screening be done for all new recruits?
http://www.straitstimes.com/ST%2BForum/ ... 48670.html
June 17, 2008
NATIONAL SERVICE TRAINING
Include stress tests, says heart specialist
I REFER to last Friday's article, 'Comprehensive heart screening for all new recruits?'.
I have strongly advocated that all new recruits should be screened more comprehensively and this screening should include a treadmill stress test and a 2D-Echo of the heart. Some of my colleagues argue that this is not necessary as the yield is small and the cost is high. They have quoted studies from the Israeli armed forces and other sources as evidence that the yield does not justify the cost.
I challenge this evidence. First, these studies are based on Israeli soldiers and United States guidelines for screening. Singapore's cohort of young recruits may deviate from this, as our incidence of various congenital heart disease may be at variance with that of Caucasians. We should not assume our pattern of disease is identical and simply extrapolate from their data.
Further, as a nation with excellent health care, we are in a position to take the lead by finding out the incidence of various heart conditions in our young recruits. For example, we know the incidence of mitral valve syndrome is more common here but we do not have exact figures.
The incidence of various congenital heart conditions that may be a harbinger of cardiac arrhythmia are as follows:
• Hypertrophic cardiomyopathy (HCM) 2:1,000
• Arrhymogenic right ventricular dysplasia 1:10,000
• Mitral valve syndrome 25:1,000
If we screen 10,000 recruits with 2D-Echoes, we may detect 300 or more recruits with abnormal heart conditions. Most will likely fall in the mitral valve syndrome category, which is relatively benign in most cases. Are all these 300 more prone to cardiac arrhythmias? We do not know at this stage, but I would certainly consider downgrading all of them to non-combat duties.
To date, the main argument against this level of screening has been twofold - other screening methods (for example, resting ECG) are in place, and the cost of treadmills and 2D-Echoes is too high. More rigorous screening (through treadmill and 2D-Echo) will cost an estimated $2 million to $5 million for 10,000 recruits, potentially saving lives while also identifying conditions that will affect our men beyond national service. As a prosperous nation, the argument of cost and benchmarking against other countries rings hollow. Should we not do everything possible to prevent sudden cardiac death in recruits?
Perhaps a telling sign comes from medical professionals themselves. I have asked several doctors if they would want their sons entering the army to be screened with a treadmill stress test and 2D-Echo. Most said yes.
Dr Leslie Lam
Two young precious sons of Singapore died while undergoing NS training recently. Naturally, parents are concerned as for many they have only one son.
Should more comprehensive heart screening be done for all new recruits?
http://www.straitstimes.com/ST%2BForum/ ... 48670.html
June 17, 2008
NATIONAL SERVICE TRAINING
Include stress tests, says heart specialist
I REFER to last Friday's article, 'Comprehensive heart screening for all new recruits?'.
I have strongly advocated that all new recruits should be screened more comprehensively and this screening should include a treadmill stress test and a 2D-Echo of the heart. Some of my colleagues argue that this is not necessary as the yield is small and the cost is high. They have quoted studies from the Israeli armed forces and other sources as evidence that the yield does not justify the cost.
I challenge this evidence. First, these studies are based on Israeli soldiers and United States guidelines for screening. Singapore's cohort of young recruits may deviate from this, as our incidence of various congenital heart disease may be at variance with that of Caucasians. We should not assume our pattern of disease is identical and simply extrapolate from their data.
Further, as a nation with excellent health care, we are in a position to take the lead by finding out the incidence of various heart conditions in our young recruits. For example, we know the incidence of mitral valve syndrome is more common here but we do not have exact figures.
The incidence of various congenital heart conditions that may be a harbinger of cardiac arrhythmia are as follows:
• Hypertrophic cardiomyopathy (HCM) 2:1,000
• Arrhymogenic right ventricular dysplasia 1:10,000
• Mitral valve syndrome 25:1,000
If we screen 10,000 recruits with 2D-Echoes, we may detect 300 or more recruits with abnormal heart conditions. Most will likely fall in the mitral valve syndrome category, which is relatively benign in most cases. Are all these 300 more prone to cardiac arrhythmias? We do not know at this stage, but I would certainly consider downgrading all of them to non-combat duties.
To date, the main argument against this level of screening has been twofold - other screening methods (for example, resting ECG) are in place, and the cost of treadmills and 2D-Echoes is too high. More rigorous screening (through treadmill and 2D-Echo) will cost an estimated $2 million to $5 million for 10,000 recruits, potentially saving lives while also identifying conditions that will affect our men beyond national service. As a prosperous nation, the argument of cost and benchmarking against other countries rings hollow. Should we not do everything possible to prevent sudden cardiac death in recruits?
Perhaps a telling sign comes from medical professionals themselves. I have asked several doctors if they would want their sons entering the army to be screened with a treadmill stress test and 2D-Echo. Most said yes.
Dr Leslie Lam