position of the UK NSC directly contradicts the National Institute for Health and Care Excellence (NICE) guidelines for transient loss of consciousness, which state that; “A 12 lead ECG is an important initial diagnostic test for identifying the likely cause of transient loss of consciousness in some people, and especially in predicting adverse events (for example, ECG abnormalities that are ‘red flag’ signs or symptoms may suggest structural heart disease or potential for arrhythmic syncope).” It is important to acknowledge that screening to reduce YSCD is a challenge, looking for more than one The current condition, some of which are fairly novel and lack UK national policy evidence-based management. However, it is is based on a gross unacceptable for policy to fall back on the lack of underestimation of the randomised controlled trials (RCTs) as the basis incidence of YSCD, the tests for insufficient evidence. In principle RCTs are used the identify people at risk, the ideal standard in research to inform policy and the management strategies and practice. However, the ideal standard is not to reduce risks. Current policy always achievable in many aspects of science is failing to prevent young (and life, in general). It would be technically sudden cardiac deaths and ethically challenging to perform a large scale in the UK randomised controlled study, particularly in light of the results of the 2006 Corrado et al. study (1) and the many studies relating to the effective management of individuals identified with an inherited cardiac disease. As part of evaluating any screening programme it is first essential to understand point one of the UK NSC Programme Appraisal Criteria: “The condition should be an important health problem”. For this there must be an accurate appraisal of the incidence of young sudden death. The latest screening report makes no reference to the data published by CRY (Papadakis et al. (2)) that informs CRY’s “12 a week” figure. This is the most important data published to date on understanding the incidence of young sudden cardiac deaths in the UK. The current UK national policy is based on a gross underestimation of the incidence of YSCD, the tests used to identify people at risk, and the management strategies to reduce risks. Current policy is failing to prevent young sudden cardiac deaths in the UK. References 1. Corrado D et al. Trends in Sudden Cardiovascular Death in Young Competitive Athletes After Implementation of a Preparticipation Screening Program. JAMA 2006;296(13):1593-1601. 2. Papadakis M et al. The magnitude of sudden cardiac death in the young: a death certificate-based review in England and Wales. Europace 2009;11(10):1353-1358.
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