Recently, there has been much discussion regarding concussion and sudden cardiac death (SCD) in young athletes. Although this is rare in children and adolescents, they are so devastating when it happens. There has been a growing effort in finding evidence-based strategies that will prevent this in a cost-effective manner. 

How common is this?
The incidence for SCD ranges 0.5 to 20 per 100,000 persons-years. Interestingly, when we compare studies from 1980s to 2009 show a rise in survival, which is attributed to improvements in community-based EMS and changes in resuscitation protocols. 

What is the cause?

• Coronary artery disease (29%)
• Primary arrhythmia like Wolff-parkinson-White syndrome (WPW) and conduction defects (22%)
• Cardiomyopathy like dilated, hypertrophic, and myocarditis (20%)
• Congenital cardiac disease like tetralogy of ballot, hypo plastic left heart syndrome and transposition of the great arteries (15%)
• Other cardiac disorders like coronary arteritis, anomalous origin of coronary arteries, aortic dissection, and mitral valve prolapse (8%)
• Unspecified disease (7%)

Interestingly:
2 years old and younger - cause of death congenital heart disease (84%)
3-13 years old - No dominant cause - congenital (21%), hypertrophic cardiomyopathy (18%), long QT 
                                    Syndrome (14%)
14-24 years old - No dominant cause - Primary arrhythmia (23%), congenital (23%), and dilated 
                                       hypertrophic cardiomyopathy (14%)
25-35 years old - Coronary artery disease 

When should I be concerned?

• chest pain
• fatigue
• passing out or lightheadedness 

What is the role for screening?
The American Heart Association (AHA) and the American Academy of Pediatrics (AAP) recommend that the most cost-effective initial screening for children and adolescents for cardiac disease is a detailed history and physical examination - ALONE. That is right, no need for unnecessary expensive testing no matter how some of these organizations market their services. 

There NO evidence that a ECG or any other cardiovascular screening program would reduce the incidence of SCD in the United States. 

Even for young athletes, there is NO evidence for routine use of ECG, echocardiography, or exercise stress testing. However, athletes older than 35 years old, some experts recommend ECG. If the athlete who is 35 years and older has moderate-to-high risk of coronary heart disease, then some experts would recommend exercise stress testing. 

Bottom line: Be careful out there as consumers are inundated with advertisements for services that can prevent cardiac disease. The truth is that unnecessary testing not only is costly, but also leads to false-positives that lead to further unnecessary testing. As with every health care topic - have a GOOD PRIMARY CARE DOCTOR to discuss issues like this and build a relationship with them so that you protect yourself from unnecessary testing that can be costly or lead to further unnecessary procedures that might expose you to harmful agents like radiation. 

To your health my friends, 
- Dr. Ahmed 

Unfortunately, we give our cars, clothes, beauty/spa treatments, homes, or entertainment desires more attention than our own health. The realization of this neglect only becomes known when we become ill or injure ourselves. 

Therefore, just like anything else, there is tremendous value in prevention and education. One thing I hear a lot is, "I am very healthy and never see a doctor." Is that a good thing? Should we see a doctor only when we are sick and vulnerable? What about seeing the doctor to discuss life's stress, maybe you are traveling and need to learn about important vaccines, learn about any public health concerns, prevent future illness?  How about losing weight? Do you really need that supplement and if so is it safe? Isn't it more costly to go to an urgent care for every minor health issue than going to a doctor who knows you and can see you that day or next day? Finally, do you really need a specialist following your chronic condition? 

We have new testing modalities that enable us to prevent heart attack or stroke in those who do not have the traditional risk factors, like smoking, high blood pressure, diabetes, or high cholesterol. 

Here is a quick chart on how our patients save if you just look at the numbers. These numbers make the following assumptions:

*Single without any dependents
*Male
*Minimum use of health care (healthcare.gov estimates) 
*Cheapest plans are selected for this comparison
*Average income of $75,000
*No primary care visit costs as some insurances charge $25-50 for each visit
*No specialist vist costs

So, if you are a couple, go to a primary care doctor currently or urgent care for your needs, have dependents, you are female, or make more money, the cost is significantly more. 

Remember 2016 Annual HSA Limits per IRS:
Self-only coverage = $3,350
Family coverage = $6,750

What about Medicare you ask? Well, Medicare patients not only save money, but have a physician who can be a true quarterback for your health care. Coordinating with specialists, home care services, preventing falls, making house calls or assisted living/independent living visits are a tremendous value. 

This probably goes without saying, but these numbers are estimates. There are so many factors that can affect your final costs. Certainly, if you end up needing surgery or need medications, then the cost will be higher. This is simply illustrated to give you a general idea at the most basic level.

​I hope this blog really clears the air a little in how insurance works with our practice. Remember, at Health Suite, you can pick LiveActive Primary Care as your primary care service or KC Family Doc. Check us out or meet us for a free consultation today! 

To your health, 
- Dr. Ahmed 
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