Community Affairs 23 February 2011
CHAIR—Thank you. Senator Siewert has two questions on two widely different issues and then that will be the end of questions on population health.
Senator SIEWERT—Children’s heart attack.
CHAIR—Is that you, Mr Smyth?
Mr Smyth—Population screening comes under population health.
Senator SIEWERT—I wanted to ask you about sudden cardiac arrest in young people. I have had correspondence about it and I have also seen some issues about it. There has been a bit of attention given to the issue. I am wondering: is it an issue that the department is aware of? Have you been looking at any statistics on it?
Ms Halton—We have our own expert. He can start.
Prof. Bishop—I am not an expert. The important thing about screening relates to whether in fact this can be screened for. It can be difficult. There is a methodology in relation to screening that has got to show that by introducing something you can show an overall reduction in mortality. It has to be of a sufficient amount to essentially justify a larger program. That is a basis on which screening things are set up. They are set up specifically on the basis of being able to show mortality reduction at a population level. While I think we all understand the individual case, I think screening is quite a different methodology. Dr Singer may like to take this a little bit further.
Dr Singer—Thank you. I do not know whether the Chief Medical Officer knows more than I do, but I am not aware of a particular screening test for this condition. There certainly are a number of tests I would regard as potential candidates. They would not be economically viable for this kind of thing over a population level. They are fairly extensive tests that would need to be done.
Senator SIEWERT—In terms of the potential screen techniques, do you say that they are expensive or do you not think there is actually a screening technique?
Dr Singer—I am not aware of a screening technique that is available for this condition, but as I said there are a couple of potential candidate screening tests. They are not really screening tests; they are diagnostic tests and they are not cost-effective in this setting.
Senator SIEWERT—I have seen wildly varying differences on how many people could potentially be affected and how many people have died as a result of this. Has the department looked at how many people have been affected by this?
Dr Singer—Not to my knowledge.
Senator SIEWERT—How do you know it would not be cost-effective if you do not know how many people have died as a result of this? I am not trying to be smart; I am just—
Dr Singer—I understand. My understanding is that this is a relatively rare condition.
Senator SIEWERT—Okay. What counts as ‘relatively rare’?
Dr Singer—I am not in a position to give you an exact figure, I am afraid.
Dr Singer—But certainly this is one where the other problem with it is that it is not a single pathological condition. It is more a syndrome in that it is something that happens, but there are a number of potential causes for it. So, as a result, usually the only way that you can identify the problem is to actually show an abnormality in the cardiac rhythm and that, I would expect, would require something like an electrophysiological study, which is a fairly invasive study and certainly is not a candidate for population screening. Simpler tests that might be a candidate, such as, for example, an electrocardiogram, do not identify cases with any reliable sensitivity. That is the main issue.
Senator SIEWERT—It seems to be the cases that you hear reported are associated a lot with young athletes.
Dr Singer—That is true, yes.
Senator SIEWERT—Is there a potential role for awareness raising or highlighting this for young athletes. Because I do not know much about it—you said there are a number of causes—I do not know if that is going to work anyway or if there is anything you could do about it.
Dr Singer—There certainly has been a reasonable amount of attention paid to this in the international literature, particularly in the US where it has been a fairly popular—that is not the right word—issue where some attention has been paid, and certainly some of the American based medical journals that I read, such as the New England Journal of Medicine and Annals of Emergency Medicine, certainly have highlighted cases where this has been an issue. Yes, I guess there is potentially the opportunity for raising awareness amongst health practitioners in this, but certainly anyone who reads the literature would be aware, anyway.
Senator SIEWERT—Thank you.