The issue of pre-screening programmes using electrocardiograms is controversial but the findings published in the British Medical Journal suggest that a family history and physical exam may miss many undiagnosed heart problems.
"Among people seeking to take part in competitive sports, exercise electrocardiograms can identify those with cardiac abnormalities," Francesco Sofi and colleagues at the Institute of Sports Medicine at the University of Florence wrote.
Last year, Sevilla footballer Antonio Puerta died three days after collapsing during a Primera Liga match and Cameroon's Marc-Vivien Foe died during a Confederations Cup match in 2003.
The risk is not just for top athletes either. Figures show one young athlete dies every three days from an unrecognised heart problem in the United States alone, the Italian researchers said.
For their study, Sofi and colleagues analysed data from more than 30,000 heart screenings during a five year period between 2002 and 2006. Italy is the only country where these tests are mandatory, Sofi added.
The study found 1,459 showed some form of heart problem during an exercise electrocardiogram and 348 people had abnormal results during their resting electrocardiogram. Of these, 159 had conditions serious enough prevent them from competing.
Yet, only six of these athletes would have been identified through a family history and physical examination, Sofi said in a telephone interview.
The results bolster arguments that the tests costing about 40 euro should be mandatory in other countries, he added.
Not everyone agrees. The American Heart Association in 2007 reaffirmed their recommendation against universal use of electrocardiography, citing cost, low prevalence of disease and a high false positive rate.
The European Society of Cardiology, International Olympic Committee and other sports league endorse the screenings on grounds on grounds some studies have found them effective, Jonathan Drezner of the University of Washington, wrote in an accompanying editorial.
"Although a detailed personal and family history and physical examination will detect an important but limited number of athletes with underlying (heart) disease, adding electrocardiography to the screening process will detect more athletes with silent cardiovascular disorders at risk of sudden death," he wrote.
