Facilitators and barriers of introducing a screening programme for sudden cardiac death (SCD)

Background: This study investigated what athletes (professional, semi – professional and amateur athletes) and medical professionals knew about Sudden Cardiac Death (SCD) and the associated risk factor screening. In addition, the study explored the main perceived barriers and facilitators of implementing a nationwide screening programme. Methods: 12 semi structured interviews were completed, 9 with athletes, between the ages of 18 – 45 years, and 3 with doctors. Interview responses aided the design of a questionnaire which further investigated athletes’ knowledge, experiences, and opinions. The questionnaire was completed by 98 athletes competing at different levels of sport, again between 18 – 45 years of age. Interview and questionnaire responses were analysed using thematic inductive analysis and descriptive statistics, respectively. Results: Interviews with athletes showed a clear consensus that there was little knowledge of SCD and SCD screening. Interview transcripts showed that athletes believed the biggest facilitator for a screening programme was peace of mind for athletes and their families, while the biggest barriers were a lack of knowledge / awareness and the potential financial costs. The mean age of the athletes who completed the questionnaire was 24.7 (± 6.3). 69% of respondents were male and most were amateur athletes (75.5%). 85% of the athlete respondents had never been screened before. Results showed that if athletes were recommended to stop participation in sport by a doctor they would adhere to this advice. Athletes believed screening was vital in all levels of sports participation and that it was equally important for males and females. Results clearly displayed that SCD risk screening would not deter athletes from sports participation and that a number of respondents, 44%, felt the choice to be screened should remain with the individual. Doctors displayed greater knowledge during interviews, but this varied and was still limited in some cases. They agreed that SCD is a significant clinical problem and that a 12 – lead ECG was an effective screening tool, enhanced by looking at family history. Doctors’ views varied on whether the incidence of SCD in the UK warranted a national screening programme. All doctors identified saving lives as a key facilitator and the main barriers revolved around the impact of screening on an athlete’s mental health, as well as concerns regarding financial implications. Conclusion: This study has obtained insight into the knowledge and perceptions of primarily athletes, along with a small sample of doctors, on the topic of SCD and SCD risk factor screening. Results identified that the main barriers currently facing the implementation of a national screening programme are, the negative impact screening can have on an individual’s mental health, severe lack of knowledge about SCD and risk screening, especially within athletes, on the topic as a whole, and the financial cost and cost effectiveness of such a programme’s implementation. The main facilitators identified were, that screening could be potentially lifesaving, peace of mind is provided to athletes and close family, and SCD factor screening as part of a pre – participation screening (PPS) programme would not deter people from sports participation