Texas debates mandatory heart testing for high school athletes

Texas lawmakers are pushing their state to become the first in the nation to require public high school athletes to undergo annual electrocardiogram (ECG) testing. Neither the American Heart Association nor the American Academy of Pediatrics recommends ECGs for routine physicals, but advocates of the legislation say it could save the lives of students like Cody Stephens.

Stephens, a high school football player, was preparing three years ago for graduation and his first college football camp when he died suddenly at home. Autopsy reports revealed a previously undetected enlarged heart. Stephens’ parents turned their grief into action, establishing a foundation that awards grants to pay for heart screenings.

“Kids are dying. Why not screen everybody?” said Cody’s father, Scott Stephens.

Advocates, including other parents who have lost children, say the testing is relatively inexpensive and easy to perform.

But the American Heart Association (AHA) has consistently maintained over the years that mandatory testing for teen athletes is not necessary. Instead, the organization recommends annual physicals that include detailed health history assessments. The AHA only recommends ECGs when the physical or health history indicates risk.

Both the AHA and the American College of Cardiology note relatively few children die of sudden cardiac arrest each year. According to Texas officials, only nine of the more than 13.6 million public middle and high school students who played sports between 2005 and 2014 died of cardiac arrest during a game or practice. That figure doesn't reflect Cody Stephens’ death, because he died at home rather than on the playing field.

“Indeed, the major cause of death in young athletes, by a factor of ten-fold, is accidents,” said Dr. Benjamin Levine, a Dallas-based cardiologist and former vice president of the American College of Sports Medicine.

The figure also does not reflect adolescents who do not play sports but also die from undiagnosed heart conditions.

Martha Lopez-Anderson’s 10-year-old son Sean collapsed and died while rollerblading in his Florida neighborhood. Lopez-Anderson responded to Sean’s death by establishing a nonprofit that advocates for and provides free heart screenings for children to detect abnormalities that are not normally discovered in routine physicals. Lopez-Anderson supports the Texas legislation.

“All eyes are on Texas. If it passes in Texas, other states will follow,” she said.

But opponents argue an ECG is limited in what it can detect. While it most likely will catch an enlarged heart, other conditions such as a coronary artery defect will go unnoticed, said Dr. Silvana Molossi, co-chair of the American College of Cardiology Sports and Exercise Council.

ECG testing also carries a false-positive rate of anywhere from 2 to 8 percent, said Molossi, meaning that the Texas plan could end up sidelining as many as 32,000 students with false positives while they pursue much more expensive follow-up procedures.

The legislation will not provide state funding for the tests. If it becomes law, Texas families will be on the hook for those charges.

The Associated Press contributed to this report.