Can we Screen for Heart Disease with a Risk of Sudden Death in Children at Public Health Centres? The ECIAP (Evaluación Cardiovascular Infantil en Atención Primaria) Study: Cardiovascular Assessment in Children in Primary Care. A multicentre observational study of screening for heart disease with a risk of sudden death.
Authors: Calero Paula Greciano , Bori Silvia Escriba , Orvay Juan Antonio Costa , Pons Nina Gonzalez , Perez María del Carmen Martin , Alfonseca Dolores Cardona , Velazquez Cristina Nogales , Vallespir Sergi Verd , Salom Alicia Esther Tur , Chiandetti Antonella , Noguera Marcos Navarro , Blanch Anna Grau , Genestar Maria Magdalena Rotger , Menendez Marianna Mambie , Hidalgo Mercedes Fernandez , Llinas Juana Maria Segui , Bon Laura Martorell , Aguilar Patricia Arestuche , Conde Beatriz Garrido , Grao Maria del Valle Sanchez , Trujillo Katia Sarraff , Alonso Antoni Muntaner , Ferragut Catalina Grimalt , Marco Andrea Soriano , Rojas Viviana Gomez , Serra Juan Pol 
Published: December 2023

Purpose
Sudden cardiac death in children is a rare event, but of great social significance. Generally, it is related to heart disease with a risk of sudden cardiac death (SCD), which may occur with cardiovascular symptoms and/or electrocardiographic markers, thus a Primary Care Paediatrician (PCP) could detect them. Therefore, we proposed a study that assesses how to put into practice and conduct a cardiovascular assessment within the routine healthy-child check-ups at six and twelve years of age; that reflects cardiovascular signs and symptoms, as well as the electrocardiographic alterations that children with a risk of SCD in the selected population present; and that assesses the PCP's skill at electrocardiogram (ECG) interpretation.
Methods
In collaboration with PCPs, primary care nurses, and paediatric cardiologists, an observational, descriptive, multicentre, cross-sectional study was carried out in the Balearic Islands (Spain), from April 2021 to January 2022, inclusive. The PCPs gathered patient data through forms (medical record, electrocardiogram, and physical examination) and sent them to the investigator, together with the informed consent document and electrocardiogram. The investigator passed the electrocardiogram on to the paediatric cardiologists for reading, in an identical form to those the paediatricians had filled in. The variables were collected, and a descriptive analysis performed.
Results
three paediatric cardiologists, twelve PCPs, and nine nurses from seven public health centres took part. They collected the data from 641 patients, but 233 patients did not participate (in 81.11% due to the PCP's workload). Therefore, the study coverage was around 64%, representing the quotient of the total number of patients who participated, divided by the total number of patients who were eligible for the study. We detected 30 patients with electrocardiographic alterations compatible with SCD risk. Nine of these had been examined by a paediatric cardiologist at some time (functional murmur in 8/9), five had reported shortness of breath with exercise, and four had reported a family history of sudden death. The physical examination of all the patients whose ECG was compatible with a risk of SCD was normal. Upon analysing to what extent the ECG results of the PCP and the paediatric cardiologist agreed: the percentage of agreement in the final interpretation (normal/altered) was 91.9%, while Cohen's kappa coefficient was 31.2% (CI 95%: 13.8% − 48.6%). The sensitivity of the ECG interpretation by the PCP to detect an ECG compatible with a risk of SCD was 29% and the positive predictive value, 45%.
Conclusions
This study lays the foundations for future SCD risk screening in children, performed by PCPs. However, previously, it would be important to optimise their training in reading and interpreting paediatric ECGs.