We appreciate the continued interest of the Padua group in our work on the important issue of mass preparticipation cardiovascular screening of competitive athletes. Corrado et al have written an extensive rebuttal to our recent report comparing mortality rates for athletes in Italy’s Veneto region with those in Minnesota. It is not possible to respond to each of the points raised by the investigators, but we would like to focus on the key issues.

Our data do not negate the results of the long-standing Italian preparticipation screening program using routine electrocardiography, which the Padua group is convinced has prevented many athlete deaths. In contrast, the data from Minnesota suggest that the less rigorous American screening process, with only history and physical examination, produces grossly similar results in terms of mortality. For this and several other reasons, there appears to be insufficient information available to justify a mandatory nationwide and annual screening program with electrocardiography for athletes in the United States. Furthermore, such a program would seem impractical, given the resources in the current United States health care system, a country of 300 million geographically dispersed residents (and perhaps 10 to 15 million competitive athletes). The most obvious obstacle is the absence of the necessary physician resources, such as with a cadre of available clinicians dedicated to the screening of competitive athletes, such as exists in Italy.

Corrado et al are concerned that our estimates of this athletic population, and therefore our incidence figures, cannot be directly compared with the Italian results. We consider our estimates reasonable, with the absolute rate of sudden deaths due to cardiovascular disease in competitive athletes in the United States probably <100 per year. Furthermore, some of these conditions, such as congenital coronary artery anomalies, cannot be reliably suspected even with routine electrocardiography.

Each death in a young individual is tragic for all concerned parties and the community. Nevertheless, it would appear that the precise frequency of athletic field deaths has been magnified by the emotion that is quite understandably attached to these sudden and unexpected events occurring in apparently healthy young individuals engaged in voluntary sports activities (otherwise generally regarded as free of such profound consequences). Therefore, although the sudden deaths of young athletes remain a compelling public health issue, there are many logistical and conceptual obstacles (and insufficient data) to justify a mandatory screening strategy with electrocardiography in the United States at this time.