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By LISA EISENHAUER

After Buffalo Bills player Damar Hamlin suffered cardiac arrest during the "Monday Night Football" game Jan. 2, the phone at AugustHeart started ringing.

AugustHeart provides free electrocardiograms for middle- and high school-aged students at events it stages in and around San Antonio. Students and parents who were shocked into action by the televised collapse of a 24-year-old professional athlete wanted to take advantage of the San Antonio-based nonprofit's next screening to check for undetected heart conditions.

By coincidence, the organization in its first partnership with the CHRISTUS Santa Rosa Health System had a screening event planned three weeks later on the campus of CHRISTUS Santa Rosa Hospital — Alamo Heights. The event was open to anyone age 13-18 in the community who preregistered. Over the course of about two hours 167 teenagers got screened.

The tests pointed to potential cardiac issues in four teens, who were referred to pediatric cardiologists. "Thanks to our wonderful doctors and our techs and volunteers, we were able to possibly save four lives," says Cathy Klumpp, executive director of AugustHeart.

Klumpp points out that heart conditions among the young are often undetected when those afflicted are asymptomatic or their symptoms are so mild they are ignored. "You don't even know," she says. "It happens without warning."

The cause of Hamlin's cardiac arrest remains unclear. He is recovering. Still, Klumpp and Jay Young, director of sports medicine for CHRISTUS Santa Rosa, both say the NFL player's collapse, which was witnessed by millions of viewers, has drawn attention to the risk of undetected heart conditions, particularly for athletes. They think it prompted the large turnout for the screening event Jan. 27.

"We were fortunate in an unfortunate way in that our first screening took place just weeks after the heart attack that occurred in Damar Hamlin," Young says. "There was this awareness about heart issues at that point."

Young is helping grow the partnership between AugustHeart and CHRISTUS Santa Rosa, part of Irving, Texas-based CHRISTUS Health. The AugustHeart screening event at the CHRISTUS facility Jan. 27 was followed by another Feb. 23.

Grief spurs action
AugustHeart was founded in 2011 by Doré Koontz and Bart Koontz, who lost their 18-year-old son, August, to hypertrophic cardiomyopathy, a genetic heart condition that causes a thickening of the heart muscle. The condition can make it harder for the heart to pump blood. The Mayo Clinic says the disease often goes undiagnosed because many people with the disease have few, if any, outward symptoms.

August Koontz was an athlete and had been through many routine sports physicals, none of which detected his heart condition before he suffered a fatal cardiac arrest in his sleep. His parents believe their son's heart condition would have been caught if he'd undergone an electrocardiogram, Klumpp says.

AugustHeart gets its funding from grants, donations and fundraising events. Since its founding, the nonprofit has provided 62,155 screenings. It claims 311 potential lives saved based on the number of athletes whose previously unknown heart abnormalities were detected in the testing. In 2022, it logged 7,864 screenings and 57 referrals. Of those who got screenings, Klumpp says 47% were in low-income families.

Parents are required to sign a waiver in order for their child or teen to undergo an electrocardiogram. The test, which registers electric signals in the heart, takes about 20 minutes. If it points to a potential heart issue, the teens undergo an echocardiogram at the event site, which shows blood flow through the heart and heart valves.

AugustHeart provides the testing equipment and pays the technicians who administer the tests. The rest of the event staff are volunteers. The tests are read by cardiologists either onsite or remotely, depending on whether doctors are available to volunteer their time on the day of the screenings.

CHRISTUS Santa Rosa Hospital — Alamo Heights donated the use of space in its orthopedic offices for the screenings. Hospital President Sherry Fraser says several of the two dozen or so volunteers at the event in January were hospital staff who had previously volunteered at AugustHeart community screenings. At some events, including the one in January, cardiologists are among the volunteers. They read test results and answer questions.

Fraser says the nonprofit's mission aligns well with that of CHRISTUS Health.

"Our mission is to extend the healing ministry of Jesus Christ," she says. "Anytime that we can touch the life of a child or anyone else, that fulfills our mission."

To screen or not to screen
The Mayo Clinic says while sudden cardiac arrest is the leading cause of death in young athletes, it remains rare. "Estimates vary, but some reports suggest that about 1 in 50,000 to 1 in 80,000 young athletes die of sudden cardiac death each year," the clinic's website says. "For comparison, the incidence of sudden cardiac arrest in the general population is about 1 in 1,000 people yearly."

The stance of AugustHeart, as stated on its website, is that "a physical exam is not enough" to detect heart problems in athletes. For its part, the American Heart Association recommends a 14-point screening for young athletes that includes a personal and family medical history and physical exam. Its recommendations do not include routine administration of electrocardiograms.

In an assessment of electrocardiogram as a screening tool for young people age 12 to 25 published in the journal Circulation in 2014, the association and the American College of Cardiology cite concerns over false positive and false negative results and the health care resources that would be consumed by such regular screenings as reasons for not recommending the test's widespread use.

A study published in 2019 in the Journal of the American Heart Association called on the association to reconsider its advice. The researchers concluded that the association's screening protocol performs poorly compared with electrocardiogram for flagging conditions associated with a risk for sudden cardiac death in high school athletes.

"Recommendations for the routine use of the AHA 14-point evaluation or similar history-based questionnaires as the principal tool for preparticipation cardiovascular screening of young athletes should be reevaluated," the assessment says.

Cody's Law
In Texas, a law enacted in 2019 requires schools to tell the parents of student athletes about the risk of sudden cardiac arrest and about electrocardiogram testing. That measure, known as "Cody's Law," is named in honor of Cody Stephens, another 18-year-old student athlete who died in his sleep of sudden cardiac arrest. The law doesn't require schools to pay for or arrange an electrocardiogram if one is requested, but Young says some schools do.

Young previously was head athletic trainer at John Marshall High School, a school in suburban San Antonio with about 2,700 students. That school included electrocardiograms as part of its preparticipation physicals for sports.

Young considers the tests "incredibly important" for the safety of young athletes. "There's just so many issues that can go undetected," he says.

The orthopedic group affiliated with CHRISTUS Santa Rosa Hospital — Alamo Heights will be providing free sports physicals later this year at events at schools in the San Antonio region. Young says the doctors plan to partner with AugustHeart to include electrocardiograms in those physicals. "We're hoping for it to be a long-term partnership," he says.