Provider Alerts

The American Academy of Pediatrics (AAP) calls for all children to be screened for conditions that can lead to cardiac arrest or death, regardless of their athletic status and particularly as they enter middle school or junior high school.

Starting at 11 years old, screen at the earliest opportunity and every 3 years or more often depending on family and Primary Care Physician (PCP) concerns. (DHCS MCQMD FAQs v7.16.25)

The AAP Recommends:

• Pediatricians and other primary care providers should evaluate if a patient’s clinical history, family history, and physical examination suggest a risk for Sudden Cardiac Arrest or Sudden Cardiac Death (SCA/SCD).
• If there is a concern, an electrocardiogram should be the first test administered, and it should be interpreted by a physician trained to recognize electrical heart disease. The doctor should factor in a patient’s clinical history and consider referral to a specialist.
• Pediatricians should advocate for emergency action plans and CPR training within the community. The use of automated external defibrillators is effective, as well, in cases of sudden cardiac arrest.
• The screening itself consists of four questions that ask if a child or teen has ever fainted or had an unexplained seizure or experienced chest pain or shortness of breath, as well as if family members have a history of cardiac conditions or death before age 50.

Screening Questions
Primary care providers can incorporate the following questions into the routine visit:

• Have you ever fainted, passed out or had an unexplained seizure suddenly and without warning, especially during exercise or in response to sudden loud noises such as doorbells, alarm clocks and ringing telephones?
• Have you ever had exercise-related chest pain or shortness of breath?
• Has anyone in your immediate family (parents, grandparents, siblings) or other more distant relatives (aunts, uncles, cousins) died of heart problems or had an unexpected sudden death before age 50? This would include unexpected drownings, unexplained car accidents in which the relative was driving or sudden infant death syndrome.
• Are you related to anyone with hypertrophic cardiomyopathy or hypertrophic obstructive cardiomyopathy, Marfan syndrome, arrhythmogenic right ventricular cardiomyopathy, long QT syndrome, short QT syndrome, Brugada syndrome or catecholaminergic polymorphic ventricular tachycardia, or anyone younger than 50 years with a pacemaker or implantable defibrillator?

What should be done with the child who has a positive finding on a screening examination or whose parents sought ECG screening and was found to have an ECG abnormality?

A positive response from the 4 questions above or an abnormal Electrocardiography (ECG) result should prompt further investigation that may include referral to a pediatric cardiologist or pediatric electrophysiologist. A pediatric electrophysiologist will have better insight into suspected channelopathies or arrhythmia issues and will recommend studies as needed. Ideally, the child with a positive response to these questions should be held out of athletic participation until the cardiovascular evaluation is complete.

A sample screening tool can be found in the Medical Record Review site tab for resources

Documentation Recommendations

• Routine Screening – document screening questions in the progress notes or scan the screening form/tool utilized in the patient’s chart.
• May include notation in the progress notes such as “No SCA/SCD risk identified” based on the 4 screening questions.
• Document next steps when SCA/SCD screening is positive to include any referrals made to a pediatric cardiologist or pediatric electrophysiologist.
• Include in the progress notes any education provided to the patient.
• Remember to schedule the patient’s next appointment prior to discharge from the clinic to monitor progress of referrals or response to treatment, if applicable.
• Inquiries on the DHCS MRR requirement regarding SCA/SCD screening can be sent to fsrteam@hpsj.com.

Visit the following links for more information about SCA/SCD:

• American Academy of Pediatrics: All Children Should Be Screened for Potential Heart-Related Issues
• Policy: Incorporate cardiac risk screening for all youths at least every 3 years
• Sudden Death in the Young: Information for the Primary Care Provider

If you have any further questions, please contact your Provider Services Representative, or call our Customer Service Department at 1-888-936-PLAN (7526). You may also visit https://www.hpsj.com/alerts/ for online access to the documents shared. The most recent information about Health Plan and our services is always available on our website www.hpsj-mvhp.org