Edinburgh Napier University

  Screening asymptomatic people with a resting electrocardiogram (ECG) has been theorised to detect latent cardiovascular disease. However, resting ECG screening is not recommended for numerous populations, such as asymptomatic middle-aged (sedentary) people, as it is not sufficiently sensitive to detect coronary artery disease. While the issues raised in this article are largely common to all screening programs, this review focuses on two distinct programs: (1) screening elite athletes for conditions associated with sudden cardiac death (SCD); and (2) screening people aged ≥65 years for atrial fibrillation (AF). These two settings have recently gained attention for their promise and concerns regarding prevention of SCD and stroke, respectively. If screening is done, it must be done well. Organisations conducting screening must consider a range of legal, ethical and logistical responsibilities which arise from the beginning to end of the process. This includes consideration of who to screen, timing of screening, whether it is mandatory, consent issues, and auditing systems to ensure quality control. Good infrastructure for interpretation of ECG results according to expert guidelines, and follow-up testing for abnormal screening results, including a pathway to treatment, are essential. Finally, there may be significant implications for those diagnosed with cardiac disease, including insurance, employment, the ability to play sport and mental health issues. There are several legal risks, and the best protective measures are good communication systems, thorough clinical records, careful handling of eligibility questions for those diagnosed, and reference to expert guidelines as the standard of car