The United States is dotted with charities named for teen athletes who died on the field of play from undiagnosed heart problems.
Despite a surge in free or low-cost cardiac testing from such groups, the incidence of sudden cardiac death among teen athletes hasn't budged in decades.
Now a Minnesota company, inspired by the 2014 death of an Eagan hockey player, is teaming up with a retired Mayo Clinic cardiologist to implement what it calls a new test to accurately rule out the 10 most common heart problems for a fraction of the typical $4,000-plus cost of a comprehensive cardiac screening.
"A diagnostic test is looking for disease. We're flipping that upside down and confirming that you are normal, because 98 percent of the kids that walk in should have normal features," said Tim Webert, founder and president of Eden Prairie's PraeVeni (pronounced "pray-venny"), which offers preventive heart screenings advertised online for $100. "If all the features are normal, we are ruling out the abnormalities that people are concerned with."
Sudden cardiac death remains a top killer of teen athletes, affecting about 3 in every 100,000. Physicians consider it a rare condition involving 75 to 100 deaths per year. One such victim was Patrick Schoonover, a hockey player from Eagan who died from undiagnosed heart defects at age 14 after collapsing on the ice during a Bantam AA game in Brainerd in November 2014.
Schoonover's parents run a charitable foundation in Patrick's name, which has conducted eight free screening events at Twin Cities schools that checked 1,400 athletes and their siblings for heart problems.
Such foundations provide cardiac screenings to about 100,000 teens per year around the country, according to a national coalition called Screen Across America, and some proponents say every kid in America should get screened.
But the medical establishment takes a dim view of mass cardiac screenings.
One month before Schoonover's death, the American Heart Association and the American College of Cardiology recommended against using electrocardiograms for compulsory mass screenings of young healthy people.
The medical groups say such screenings "may be considered" for small groups of athletes and non-athletes, but only with "close physician involvement." The problem is that the medical device commonly used for such screenings — a 12-lead electrocardiogram machine — can lead to false-positive and false-negative results that are expensive to resolve and tough emotionally on young athletes and their families.
In addition, there's no evidence that athletes carry a higher risk of suddenly dying from a heart condition than other people of the same age. About 300,000 Americans of all ages die of sudden cardiac death each year, and usually less than 100 are young athletes, said Dr. Douglas Zipes, a well-known Indiana cardiologist.
"If you've lost a son or daughter in the prime of their young lives, it's an absolutely heartbreaking, horrendous event," Zipes said. "But if we're talking about putting lots of resources behind an effort, where are you going to get the bang for the buck? It's not going to be trying to save 75 to 100 athletes with the screening. You're going to miss a certain number of them because our screening techniques are not 100 percent accurate."
A new approach
Minnesota's PraeVeni grew out of a concern to address those problems, but in a different way than volunteer organizations like the Patrick Schoonover Heart Foundation or professional medical practices do.
PraeVeni uses ultrasound scanners, not the 12-lead electrocardiograms that are criticized for producing too many false positives and false negatives. Electrocardiograms produce the familiar wavy line that flits up and down with the heart's electrical activity, requiring deep medical experience to correctly interpret, while an echocardiogram looks like a grainy black-and-white video surrounded by data readouts, the same as an ultrasound used during pregnancy.
PraeVeni's office is not a medical facility, so it doesn't charge the medical-grade prices needed to support a large modern hospital or cardiology practice. The 15-minute, prepaid exams are conducted by a trained sonographer in private rooms at the Eden Prairie offices. Often the price is subsidized by a school or athletic group such as the Osseo Maple Grove Hockey Association.
The company has screened 1,371 participants, with 2 percent showing signs of abnormalities, Webert said.
Webert said he was inspired to quit his job as a marketing vice president with Carlson Wagonlit Travel and start the business after watching Schoonover collapse on the ice in 2014. Webert has never been involved with the family-run Schoonover foundation, though in interviews, PraeVeni and the foundation express no ill will toward each other.
PraeVeni has no physician on staff, which Webert said enables him to keep prices low. That doesn't mean the company's methods lack medical rigor, according to Dr. James Seward, the retired Mayo Clinic cardiologist and echocardiogram enthusiast who designed the company's screening protocol.
A typical echocardiogram may display 100 or more pieces of data, but PraeVeni focuses on a subset of 10 physical features of the heart — narrowing the inquiry "to things that will kill you," Seward says. And rather than hunting for defects like a traditional screening, PraeVeni's sonographers use echo images to positively affirm 10 normal features in the heart, like valve and vascular anatomy, atrial-output volume, and blood pressure and velocity.
By confirming normal features, Seward said, PraeVeni can cheaply and "unequivocally" rule out 10 of the most common heart problems. In the 2 percent of cases in which normality can't be confirmed on ultrasound, families are referred for a free consult to Seward or a practicing Mayo Clinic pediatric cardiologist.
Seward sees PraeVeni as a sign of an inevitable shift away from expensive diagnostic medicine and toward more efficient preventive care. "This era of the paradigm shift, from diagnostic to preventive medicine, will have a profound effect. What we are doing today doesn't work. It really doesn't," he said.
PraeVeni is challenging the status quo, and it has its skeptics in the medical establishment and among community-based screening groups.
Both Zipes and Darren Sudman, executive director of the Philadelphia-based charity that operates Screen Across America, noted that "echo" images would not be able to capture electrical abnormalities in the heart.
Seward said electrical problems in the heart are rare and there's no evidence that traditional electrocardiograms for screening work on patients who show no outward sign of disease.
The Twin Cities-based Patrick Schoonover Heart Foundation will continue hold its free community screening events, which include echocardiogram scans in addition to electrocardiograms and a traditional family health history questionnaire, said Patrick's father and charity organizer Mike Schoonover. Since 2015, the foundation has screened 1,400 teens and found four with potentially life-threatening problems. Two have already been treated, he said.
Sudman said the community foundations around the country will continue their work, but he's encouraged by PraeVeni's approach.
"I am a big believer that the for-profit companies are the next step for our movement," Sudman said. "The role of the nonprofit is to start heart screenings, gather data, and prove a concept. And then it's the role of the for-profit … to actually figure out how this could become a scalable solution."
Joe Carlson • 612-673-4779