Population-based screening for conditions associated with juvenile sudden cardiac death: a systematic review and meta-analysis

AIMS: Juvenile sudden cardiac death (SCD) is predominantly caused by inherited or congenital heart conditions. While structured screening programmes for competitive athletes are well established, current international guidelines emphasize a gap of evidence regarding the value of mass screening in the general youth population. This systematic review aimed to assess the effectiveness of large-scale screening programmes in detecting conditions associated with SCD among young individuals. METHODS AND RESULTS: We conducted a systematic review following PRISMA guidelines, with the protocol registered in PROSPERO (CRD42024540606). Original studies evaluating cardiovascular screening in young individuals were included, while studies exclusively involving competitive athletes were excluded. Nineteen studies encompassing 1 079 781 participants from multiple countries were finally analysed. Most studies (68%) were published recently and primarily targeted children and adolescents aged 6-19 years; 63% were assessed as having a low risk of bias. Screening modalities included electrocardiography (ECG) alone (26.3%), questionnaires alone (5.3%), and a combination of both (68.4%). Following second- or third-line investigations, the overall diagnostic yield for SCD-risk conditions was 1.4‰ (1.9‰ in the meta-analysis). The pooled prevalence, estimated using a random-effects model, was 2.23‰ (95% CI: 0.94-5.29‰), with extremely high heterogeneity among studies (I2 = 100%, P < 0.0001). CONCLUSION: Systematic cardiovascular screening may help identify young individuals at increased risk for SCD, providing a potentially meaningful diagnostic yield. However, the absence of long-term data on outcome and cost-effectiveness underscores the need for further research to refine screening protocols, assess sustainability, and inform evidence-based public health policies.