{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T07:36:00Z","timestamp":1776065760913,"version":"3.50.1"},"reference-count":34,"publisher":"Oxford University Press (OUP)","issue":"16","license":[{"start":{"date-parts":[[2023,9,5]],"date-time":"2023-09-05T00:00:00Z","timestamp":1693872000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,11,9]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Aims<\/jats:title>\n                  <jats:p>The role of pre-participation screening (PPS) modalities in preventing sudden cardiac death (SCD) in athletes is debated due to a high false-positive rate. Focused cardiac ultrasound (FoCUS) has shown higher sensitivity and specificity, but its cost-effectiveness remains uncertain. This study aimed to determine the diagnostic performance and cost-effectiveness of FoCUS use in PPS.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods and results<\/jats:title>\n                  <jats:p>A total of 2111 athletes (77.4% male, mean age 24.9 \u00b1 15.2years) underwent standardized family and medical history collection, physical examination, resting electrocardiography (ECG), FoCUS (10 min\/5 views protocol), comprehensive echocardiography and exercise stress test. We prospectively evaluated three PPS incremental models: Model A, standardized medical history and physical examination Model B, Model A plus resting and stress ECG and Model C, Model B plus FoCUS (10 min\/5 views protocol). We determined their incremental diagnostic accuracy and cost-effectiveness ratio. A total of 30 athletes were diagnosed with a cardiac condition associated with SCD: 3 were identified by Model A, 14 by Model B, and 13 athletes by Model C. The introduction of FoCUS markedly increased the sensitivity of PPS, compared with Model A and Model B (sensitivity 94% vs. 19% vs. 58% specificity 93% vs. 93% vs. 92%). The total screening costs were as follows: Model A 35.64 euros, Model B 87.68 euros, and Model C 120.89 euros. Considering the sole conditions at risk of SCD, the incremental cost-effectiveness ratio was 135.62 euros for Model B and 114.31 for Model C.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>The implementation of FoCUS into the PPS allows to identify a significantly greater number of athletes at risk of SCD and markedly lowers the false negative rate. Furthermore, the incorporation of FoCUS into the screening process has shown to be cost-effective.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/eurjpc\/zwad287","type":"journal-article","created":{"date-parts":[[2023,9,5]],"date-time":"2023-09-05T13:51:38Z","timestamp":1693921898000},"page":"1748-1757","source":"Crossref","is-referenced-by-count":10,"title":["Cost-effectiveness and diagnostic accuracy of focused cardiac ultrasound in the pre-participation screening of athletes: the SPORT-FoCUS study"],"prefix":"10.1093","volume":"30","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7220-123X","authenticated-orcid":false,"given":"Geza","family":"Halasz","sequence":"first","affiliation":[{"name":"Cardiology Department, Azienda Ospedaliera SanCamillo Forlanini , Circonvallazione Gianicolense, 87, Rome 00152 , Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bruno","family":"Capelli","sequence":"additional","affiliation":[{"name":"Sport and Exercise Medicine, Istituto Cardiocentro Ticino, Ente Ospedaliero Cantonale , Lugano , Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alessia","family":"Nardecchia","sequence":"additional","affiliation":[{"name":"Italian Ministry of Education and Research, I.I.S Ceccano , Via Gaeta 105, Ceccano 03023 , Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mattia","family":"Cattaneo","sequence":"additional","affiliation":[{"name":"Cardiologia, Centro Medico , Lugano , Switzerland"},{"name":"Cardiology Department, Istituto Cardiocentro Ticino, Ente Ospedaliero Cantonale , Lugano , Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tiziano","family":"Cassina","sequence":"additional","affiliation":[{"name":"Cardiac Anesthesia and Intensive Care, Istituto Cardiocentro Ticino, Ente Ospedaliero Cantonale , Lugano , Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vincenzo","family":"Biasini","sequence":"additional","affiliation":[{"name":"Centro di Medicina dello Sport I\u00b0 Livello Sport Medicine and Exercise Medicine, , L\u2019Aquila 67100 , Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Davide","family":"Barbieri","sequence":"additional","affiliation":[{"name":"Department of Neuroscience and Rehabilitation, University of Ferrara , Corso Ercole I d\u2019Este 32, Ferrara , Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michele","family":"Villa","sequence":"additional","affiliation":[{"name":"Cardiac Anesthesia and Intensive Care, Istituto Cardiocentro Ticino, Ente Ospedaliero Cantonale , Lugano , Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7161-3224","authenticated-orcid":false,"given":"Matteo","family":"Beltrami","sequence":"additional","affiliation":[{"name":"Cardiology Unit, San Giovanni di Dio Hospital , Florence 50142 , Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francesco","family":"Perone","sequence":"additional","affiliation":[{"name":"Cardiac Rehabilitation Unit, Rehabilitation Clinic \u2018Villa delle Magnolie\u2019, Castel Morrone , Caserta 81020 , Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matteo","family":"Villani","sequence":"additional","affiliation":[{"name":"Intensive Care Unit, G. 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