A Model of Cardiac Preparticipation Screening for Sports Competition in Indonesia: Challenges and Future Perspectives
Keywords:
Sport Cardiology, Indonesia, Screening
Abstract
Sudden cardiac death (SCD) among athletes remains a preventable tragedy, yet Indonesia lacks a national registry, standardized protocols, and systematic data amid rising coronary artery disease prevalence and regional cardiovascular risks unique to the Asia-Pacific. While countries like Italy have reduced SCD by 89% through mandatory electrocardiogram-based screening, Indonesia's Law No. 11 of 2022 mandates athlete health services without specifying cardiac preparticipation screening (CPS) details, resulting in inconsistent implementations across events like the quadrennial Pekan Olahraga Nasional (PON).
This editorial proposes a feasible, cost-effective CPS model—history, physical exam, and 12-lead ECG using 2017 International Criteria—for PON athletes, delivered via Indonesian Heart Association, national sports committee, and ministry partnerships. Piloted with trained general practitioners and cardiologists at training centres, it aligns with WHO screening criteria, costs per athlete, and reserves echocardiography for high-risk cases.
By generating Indonesia's first athlete SCD data, enhancing provider training, and enabling scalable nationwide rollout, this framework promises to quantify risks, avert fatalities, and position Indonesia as a leader in equitable sports cardiology for resource-constrained settings, transforming competitive sport from potential peril to unalloyed benefit.
Downloads
Download data is not yet available.
References
1. Vessella T, Zorzi A, Merlo L, Pegoraro C, Giorgiano F, Trevisanato M, et al. The Italian preparticipation evaluation programme: Diagnostic yield, rate of disqualification and cost analysis. Br J Sports Med. 2020 Feb 1;54(4):231–7. doi:10.1136/bjsports-2018-100293 PubMed PMID: 31315826.
2. Philippine Heart Association. (2026). Statement on preparticipation cardiovascular screening of athletes in the Philippines. https://www.philheart.org/pha2025/pha-latest-news/philippine-heart-association-statement-on-preparticipation-cardiovascular-screening-of-athletes-in-the-philippines
3. Rappa A. Katalog Data - Layanan Permintaan Data [Internet]. [cited 2025 Jan 27]. Available from: https://layanandata.kemkes.go.id/katalog-data/riskesdas/ketersediaan-data/riskesdas-2018
4. Wang L, Yeo TJ, Tan B, Destrube B, Tong KL, Tan SY, et al. Asian Pacific Society of Cardiology consensus recommendations for pre-participation screening in young competitive athletes. Eur Cardiol. 2021 Feb;16:e44. doi:10.15420/ecr.2021.12 PubMed PMID: 34035814.
5. Halabchi F, Seif-Barghi T, Mazaheri R. Sudden cardiac death in young athletes; a literature review and special considerations in Asia. Asian J Sports Med. 2011 Mar;2(1):1–15. doi:10.5812/asjsm.27752 PubMed PMID: 22375200.
6. Corrado, D., Basso, C., Pavei, A., Michieli, P., Schiavon, M., & Thiene, G. (2006). Trends in sudden cardiovascular death in young competitive athletes after implementation of a preparticipation screening program. JAMA, 296(13), 1593–1601. https://doi.org/10.1001/jama.296.13.1593
7. Maron, B. J., Thompson, P. D., Ackerman, M. J., Balady, G., Berger, S., Cohen, D., Dimeff, R., Douglas, P. S., Glover, D. W., Hutter, A. M., Jr, Krauss, M. D., Maron, M. S., Mitten, M. J., Roberts, W. O., Puffer, J. C., & American Heart Association Council on Nutrition, Physical Activity, and Metabolism (2007). Recommendations and considerations related to preparticipation screening for cardiovascular abnormalities in competitive athletes: 2007 update: a scientific statement from the American Heart Association Council on Nutrition, Physical Activity, and Metabolism: endorsed by the American College of Cardiology Foundation. Circulation, 115(12) https://doi.org/10.1161/CIRCULATIONAHA.107.181423
8. Kemenpora. Undang-Undang No. 11 Tahun 2022 tentang Sistem Keolahragaan Nasional [Internet]. [cited 2025 Feb 3]. Available from: UU No. 11 Tahun 2022
9. Dvorak J, Grimm K, Schmied C, Junge A. Feasibility of precompetition medical assessment at FIFA World Cups for female youth players. Br J Sports Med. 2012 Dec;46(16):1132–3.
10. Republik Indonesia. Peraturan Pemerintah Nomor 8 Tahun 2015 tentang Jenis dan Tarif atas Jenis Penerimaan Negara Bukan Pajak yang Berlaku pada Kementerian Pemuda dan Olahraga. 2015.
11. Wilson JM, Jungner YG. Principles and practice of mass screening for disease. Bol Oficina Sanit Panam. 1968 Oct;65(4):281–393.
12. Maron BJ, Levine BD, Washington RL, Baggish AL, Kovacs RJ, Maron MS. Eligibility and disqualification recommendations for competitive athletes with cardiovascular abnormalities: Task force 2: Preparticipation screening for cardiovascular disease in competitive athletes: A scientific statement from the American heart association and American college of cardiology. J Am Coll Cardiol. 2015 Dec 1;66(21):2356–61.
13. Maron BJ, Friedman RA, Kligfield P, Levine BD, Viskin S, Chaitman BR, et al. Assessment of the 12-lead electrocardiogram as a screening test for detection of cardiovascular disease in healthy general populations of young people (12-25 years of age): a scientific statement from the American Heart Association and the American College of Cardiology. J Am Coll Cardiol. 2014 Oct 7;64(14):1479–514.
14. Petek BJ, Baggish AL. Pre-participation cardiovascular screening in young competitive athletes. Curr Emerg Hosp Med Rep. 2020 Sep;8(3):77–89.
15. Dunn TP, Pickham D, Aggarwal S, Saini D, Kumar N, Wheeler MT, et al. Limitations of current AHA guidelines and proposal of new guidelines for the preparticipation examination of athletes. Clin J Sport Med. 2015 Nov;25(6):472–7.
16. Fudge J, Harmon KG, Owens DS, Prutkin JM, Salerno JC, Asif IM, et al. Cardiovascular screening in adolescents and young adults: a prospective study comparing the Pre-participation Physical Evaluation Monograph 4th Edition and ECG. Br J Sports Med. 2014 Aug;48(15):1172–8.
17. Pelliccia A, Sharma S, Gati S, Bäck M, Börjesson M, Caselli S, et al. 2020 ESC Guidelines on sports cardiology and exercise in patients with cardiovascular disease. Russ J Cardiol. 2021 Jun 11;26(5):4488.
18. Corrado D, Basso C, Pavei A, Michieli P, Schiavon M, Thiene G. Trends in sudden cardiovascular death in young competitive athletes after implementation of a preparticipation screening program. JAMA. 2006 Oct 4;296(13):1593–601.
19. Harmon KG, Zigman M, Drezner JA. The effectiveness of screening history, physical exam, and ECG to detect potentially lethal cardiac disorders in athletes: a systematic review/meta-analysis. J Electrocardiol. 2015 May;48(3):329–38.
20. Sharma S, Drezner JA, Baggish A, Papadakis M, Wilson MG, Prutkin JM, et al. International recommendations for electrocardiographic interpretation in athletes. Eur Heart J. 2018 Apr 21;39(16):1466–80.
21. Yeo TJ, Wang M, Grignani R, McKinney J, Koh LP, Tan FHY, et al. Electrocardiographic and echocardiographic insights from a prospective registry of Asian elite athletes. Front Cardiovasc Med. 2021;8:799129.
22. Baggish AL, Battle RW, Beaver TA, Border WL, Douglas PS, Kramer CM, et al. Recommendations on the use of multimodality cardiovascular imaging in young adult competitive athletes: A report from the American society of echocardiography in collaboration with the society of cardiovascular computed tomography and the society for cardiovascular magnetic resonance. J Am Soc Echocardiogr. 2020 May;33(5):523–49.
23. Donati F, Guicciardi C, Lodi E, Modena MG, Palermi S, Biffi A, et al. 320 the potential role of echocardiography in the pre-participation screening: Results of an observational retrospective study. Eur Heart J Suppl [Internet]. 2022 Dec 15;24(Supplement_K). Available from: http://dx.doi.org/10.1093/eurheartjsupp/suac121.701
2. Philippine Heart Association. (2026). Statement on preparticipation cardiovascular screening of athletes in the Philippines. https://www.philheart.org/pha2025/pha-latest-news/philippine-heart-association-statement-on-preparticipation-cardiovascular-screening-of-athletes-in-the-philippines
3. Rappa A. Katalog Data - Layanan Permintaan Data [Internet]. [cited 2025 Jan 27]. Available from: https://layanandata.kemkes.go.id/katalog-data/riskesdas/ketersediaan-data/riskesdas-2018
4. Wang L, Yeo TJ, Tan B, Destrube B, Tong KL, Tan SY, et al. Asian Pacific Society of Cardiology consensus recommendations for pre-participation screening in young competitive athletes. Eur Cardiol. 2021 Feb;16:e44. doi:10.15420/ecr.2021.12 PubMed PMID: 34035814.
5. Halabchi F, Seif-Barghi T, Mazaheri R. Sudden cardiac death in young athletes; a literature review and special considerations in Asia. Asian J Sports Med. 2011 Mar;2(1):1–15. doi:10.5812/asjsm.27752 PubMed PMID: 22375200.
6. Corrado, D., Basso, C., Pavei, A., Michieli, P., Schiavon, M., & Thiene, G. (2006). Trends in sudden cardiovascular death in young competitive athletes after implementation of a preparticipation screening program. JAMA, 296(13), 1593–1601. https://doi.org/10.1001/jama.296.13.1593
7. Maron, B. J., Thompson, P. D., Ackerman, M. J., Balady, G., Berger, S., Cohen, D., Dimeff, R., Douglas, P. S., Glover, D. W., Hutter, A. M., Jr, Krauss, M. D., Maron, M. S., Mitten, M. J., Roberts, W. O., Puffer, J. C., & American Heart Association Council on Nutrition, Physical Activity, and Metabolism (2007). Recommendations and considerations related to preparticipation screening for cardiovascular abnormalities in competitive athletes: 2007 update: a scientific statement from the American Heart Association Council on Nutrition, Physical Activity, and Metabolism: endorsed by the American College of Cardiology Foundation. Circulation, 115(12) https://doi.org/10.1161/CIRCULATIONAHA.107.181423
8. Kemenpora. Undang-Undang No. 11 Tahun 2022 tentang Sistem Keolahragaan Nasional [Internet]. [cited 2025 Feb 3]. Available from: UU No. 11 Tahun 2022
9. Dvorak J, Grimm K, Schmied C, Junge A. Feasibility of precompetition medical assessment at FIFA World Cups for female youth players. Br J Sports Med. 2012 Dec;46(16):1132–3.
10. Republik Indonesia. Peraturan Pemerintah Nomor 8 Tahun 2015 tentang Jenis dan Tarif atas Jenis Penerimaan Negara Bukan Pajak yang Berlaku pada Kementerian Pemuda dan Olahraga. 2015.
11. Wilson JM, Jungner YG. Principles and practice of mass screening for disease. Bol Oficina Sanit Panam. 1968 Oct;65(4):281–393.
12. Maron BJ, Levine BD, Washington RL, Baggish AL, Kovacs RJ, Maron MS. Eligibility and disqualification recommendations for competitive athletes with cardiovascular abnormalities: Task force 2: Preparticipation screening for cardiovascular disease in competitive athletes: A scientific statement from the American heart association and American college of cardiology. J Am Coll Cardiol. 2015 Dec 1;66(21):2356–61.
13. Maron BJ, Friedman RA, Kligfield P, Levine BD, Viskin S, Chaitman BR, et al. Assessment of the 12-lead electrocardiogram as a screening test for detection of cardiovascular disease in healthy general populations of young people (12-25 years of age): a scientific statement from the American Heart Association and the American College of Cardiology. J Am Coll Cardiol. 2014 Oct 7;64(14):1479–514.
14. Petek BJ, Baggish AL. Pre-participation cardiovascular screening in young competitive athletes. Curr Emerg Hosp Med Rep. 2020 Sep;8(3):77–89.
15. Dunn TP, Pickham D, Aggarwal S, Saini D, Kumar N, Wheeler MT, et al. Limitations of current AHA guidelines and proposal of new guidelines for the preparticipation examination of athletes. Clin J Sport Med. 2015 Nov;25(6):472–7.
16. Fudge J, Harmon KG, Owens DS, Prutkin JM, Salerno JC, Asif IM, et al. Cardiovascular screening in adolescents and young adults: a prospective study comparing the Pre-participation Physical Evaluation Monograph 4th Edition and ECG. Br J Sports Med. 2014 Aug;48(15):1172–8.
17. Pelliccia A, Sharma S, Gati S, Bäck M, Börjesson M, Caselli S, et al. 2020 ESC Guidelines on sports cardiology and exercise in patients with cardiovascular disease. Russ J Cardiol. 2021 Jun 11;26(5):4488.
18. Corrado D, Basso C, Pavei A, Michieli P, Schiavon M, Thiene G. Trends in sudden cardiovascular death in young competitive athletes after implementation of a preparticipation screening program. JAMA. 2006 Oct 4;296(13):1593–601.
19. Harmon KG, Zigman M, Drezner JA. The effectiveness of screening history, physical exam, and ECG to detect potentially lethal cardiac disorders in athletes: a systematic review/meta-analysis. J Electrocardiol. 2015 May;48(3):329–38.
20. Sharma S, Drezner JA, Baggish A, Papadakis M, Wilson MG, Prutkin JM, et al. International recommendations for electrocardiographic interpretation in athletes. Eur Heart J. 2018 Apr 21;39(16):1466–80.
21. Yeo TJ, Wang M, Grignani R, McKinney J, Koh LP, Tan FHY, et al. Electrocardiographic and echocardiographic insights from a prospective registry of Asian elite athletes. Front Cardiovasc Med. 2021;8:799129.
22. Baggish AL, Battle RW, Beaver TA, Border WL, Douglas PS, Kramer CM, et al. Recommendations on the use of multimodality cardiovascular imaging in young adult competitive athletes: A report from the American society of echocardiography in collaboration with the society of cardiovascular computed tomography and the society for cardiovascular magnetic resonance. J Am Soc Echocardiogr. 2020 May;33(5):523–49.
23. Donati F, Guicciardi C, Lodi E, Modena MG, Palermi S, Biffi A, et al. 320 the potential role of echocardiography in the pre-participation screening: Results of an observational retrospective study. Eur Heart J Suppl [Internet]. 2022 Dec 15;24(Supplement_K). Available from: http://dx.doi.org/10.1093/eurheartjsupp/suac121.701
Published
2026-03-31
Views & Downloads
Abstract views: 91
PDF downloads: 79
PDF downloads: 79
How to Cite
Desandri, D., & Aslani, A. (2026). A Model of Cardiac Preparticipation Screening for Sports Competition in Indonesia: Challenges and Future Perspectives. Indonesian Journal of Cardiology, 47(1). https://doi.org/10.30701/ijc.2156
Section
Editorial Review
Copyright (c) 2026 Indonesian Journal of Cardiology
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access).
