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IU School of Medicine physician leads player heart safety screenings at annual NFL Scouting Combine in Indianapolis.

Feb. 26, 2013

One of the “most high-profile programs no one knows about” is how the doctor in charge describes the IU School of Medicine’s role in the National Football League Scouting Combine, an annual event designed to test the mettle of pro football’s top prospects at Lucas Oil Stadium in Indianapolis.

More than 350 potential NFL draftees begin the barrage of mental and physical tests that make up the nearly weeklong event, which ended Feb. 26, with a series of heart exams overseen by Richard Kovacs, M.D., in a first-floor conference room at IU Health Methodist Hospital.

Richard Kovacs

Richard Kovacs, M.D., sits in one of the exam areas set up to test the heart health of players in town for the annual NFL Scouting Combine in Indianapolis | PHOTO BY LIZ KAYE

“This is the third year of a three-year effort,” said Dr. Kovacs, associate dean for clinical research and professor of clinical medicine at the IU School of Medicine and clinical director of the Krannert Institute of Cardiology. “About 400 athletes from all sports at all levels die each year in the United States from undetected heart abnormalities. I’m very involved the effort to stop this happening.”

Dr. Kovacs and colleagues will present their preliminary test results at the NFL Headquarters in New York in April.

Many players who get their heart checked at IU come straight to the testing site from their airplane or hotel, where they’re greeted by volunteers who lead them to tables marked “players,” littered with Gatorade and fitness magazines. Each series of tests takes about an hour, including an electrocardiogram, or “EKG”; a standard echocardiogram; a second, more advanced echocardiogram; and a special station with a treadmill for anyone whose results require extra investigation.

The machines are loaned by equipment-makers such as Philips and General Electric, which are eager to contribute to the project. Another station contains a row of computer screens for technicians to review results.

“This is like a military operation; it takes an army,” Dr. Kovacs said. “We take over the conference room. We bring in five extra echo machines, an advanced echo machine, a whole bunch of EKGs, treadmills, extra shifts of technicians, volunteers. We draw from all across IU Health. It’s a whole separate operation; we don’t interfere with what goes on at the hospital.”

Altogether, it takes four straight days working into the late evening to test every player coming through the combine.

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Dr. Kovacs and a nurse assistant, Tracy Taylor, examine an EKG readout from a player. | PHOTO BY LIZ KAYE

“We’re the choke point,” Dr. Kovacs said. “No one goes to Lucas Oil until they go through us.”

The captain of his Division III team at the University of Chicago, Dr. Kovacs knows football. He played as a strong safety/halfback in college and as a member of his high school football team in Elyria, Ohio. The small town has produced more than its share of professional football players, including Vic Janowicz, 1950 Heisman Trophy recipient, and Joe Staysniak, a former Indianapolis Colt and local radio announcer. This experience drives Dr. Kovacs to make the game safer for those among the sport’s most elite ranks, as well as college- and high school-level players.

“This is about screening, but it’s also about science,” Dr. Kovacs said. “This is the third year that we’ve done a very specific screening with echocardiograms and electrocardiograms, the same for each player, and at the end of these three years we’re going to evaluate this critically and scientifically.”

Previously, NFL Scouting Combine participants received EKGs, which provide less in-depth results, but not echocardiograms. After Dr. Kovacs and his collaborates present their data in April, the NFL will review the results of the program — including any heart abnormalities detected and how those discoveries affected team decisions about players — and chose whether to continue the screenings. Currently, Dr. Kovacs said, the NFL is encouraged to follow the eligibility recommendations for competitive athletes established by the American College of Cardiology.

“We’ve now got heart data for about 1,000 elite athletes,” Dr. Kovacs said. “This will not only influence future guidelines but also help establish ‘healthy norms’ for athletes. Right now we don’t really have a lot of heart data on people who weigh 350 pounds and can run a 40-yard dash in 4.5 seconds. What applies to ‘mere mortals’ doesn’t really apply to these players.”

Dr. Kovacs’ partners in continued development of the eligibility guidelines include Douglas P. Zipes, M.D., Distinguished Professor Emeritus at the IU School of Medicine, and Barry J. Maron, M.D., of the Minneapolis Heart Institute. His partners in the data analysis project include physicians and researchers from MedStar, a hospital system affiliated with George Washington University serving Maryland and the District of Columbia, and the NFL’s cardiovascular committee.

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Dr. Kovacs and team review players' heart readouts from a bank of computer screens in the exam area set up at IU Health Methodist Hospital by IU's Krannert Institute of Cardiology. | PHOTO BY LIZ KAYE

“The NFL really wants to get this right,” said Dr. Kovacs, who also co-chairs the Sports Cardiology Section for the American College of Cardiology. “They’ve already given about $40 million to the National Institutes of Health for independent research on safety in professional football.”

Despite basic screenings at the high school- and college-level, Dr. Kovacs added that about two or three athletes screened at the combine each year generate a “red flag,” indicating the need for further evaluation. This is a much higher rate than what appears in the average population. All players’ results are passed along to team doctors at Lucas Oil.

The “red flag” results are surprising since most colleges have screening programs and states require a basic physical exam before allowing students to participate in school sports. However, Dr. Kovacs points out that debate continues over whether screenings are effective at preventing sudden cardiac death in athletes. Nor do these basic exams include EKGs or echocardiograms, with more advanced screening efforts generally funded by independent organizations, such as the John Stewart Foundation in Indianapolis.

“These tragic deaths can take the wind out of a community,” Dr. Kovacs said. “When an athlete dies, it’s usually someone young, someone in the peak of health, someone who’s idolized -- and it usually happens in a very visible place, on the court or on the playing field. I’m trying to apply science so we can detect these things and respond in the right way.

“This isn’t just about professional football,” he added. “It’s also about safety in college, safety in high school and safety in sports in general.”

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