Beginning next year, the U.S. military is expected to screen all potential recruits for cardiac anomalies under a new program designed to reduce deaths at boot camp and beyond.

The current version of the fiscal 2024 National Defense Authorization Act, expected to pass Congress this month, requires the Defense Department to launch a pilot program by next October to give electrocardiograms, also known as ECGs or EKGs, to anyone who undergoes a military accession screening.

The provision follows a move in 2022 that extended an EKG screening program at the U.S. Naval Academy^[1] to the Air Force Academy^[2] and West Point^[3]. The Naval Academy began conducting the screenings shortly after losing two students to cardiac arrest during a three-week span in February 2020^[4].

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The push to expand cardiac screenings to all potential military recruits came largely from the families of service members who died^[6] from heart conditions that might have been detected by an EKG.

Laurie Finlayson and her husband John founded Lion Heart Heroes Foundation in 2014 to raise awareness of sudden cardiac arrest after their son, Marine Lance Cpl. David Finlayson, 25, died during a battalion training run in 2013. His autopsy revealed an enlarged heart.

When the Finlaysons learned that David had never received an EKG at his military entrance processing station, or MEPS, they began lobbying Congress for the change. After learning that a widespread mandatory pilot was included in the final version of the defense bill last week, Laurie Finlayson described it as "very exciting."

"We want what is best for every recruit. However they push this out, it gets more people screened, it gets good data out into the world, and it will make a huge difference in this whole movement going forward," Finlayson said during an interview Friday.

EKGs were part of routine screening to join the U.S. military as recently as 2002. But they were notoriously famous for false positives, requiring expensive follow-on medical testing and handing young people potentially life-changing misdiagnoses, so they were dropped by the services.

Finlayson said part of Lion Heart Heroes' push has been trying to educate the Pentagon on advancements in EKG technology that have made the tests more reliable, with false positive rates dropping significantly in the past decade.

The first cardiac screening of the Naval Academy's more than 4,000 Midshipmen in 2020 found 87 with abnormal tests. Of those, 19 had cardiac issues that could result in serious cardiac events. Six received curative treatment, 11 were put on monitoring, and two were medically separated, according to the foundation.

"The military has been way, way, way behind, and I feel like my role has been bringing them up to speed on the technology and the difference it can make," Finlayson said.

The Biden administration in July announced its opposition to the proposed legislation, calling it "unnecessary" and saying it would increase the cost and time needed for screening potential recruits.

"The requirement may restrict the ability to effectively screen and process applicants at Military Entrance Processing Stations and establishes reporting and screening requirements that are unnecessary for the target age of the recruiting^[7] population," according to a statement issued by the Office of Management and Budget.

But sudden cardiac arrest is the leading cause of non-traumatic sudden death in the U.S. military, especially among recruits, according to Defense Department data.

In a study by leading military cardiologists, 108 of the 126 non-traumatic sudden deaths in the military were related to exercise and more than half of the cases demonstrated a clearly identifiable cardiac abnormality at autopsy.

The mortality rate of sudden cardiac death, or SCD, among recruits 19 years and younger is 6.6 per 100,000 recruit-years, compared with 2.3 per 100,000 NCAA college athlete-years. Death rates are higher among male recruits, at 7.1 per 100,000, than females, at 3.8 per 100,000. And SCD affects black recruits disproportionately -- 12 per 100,000, compared with all other non-African American recruits, at 5.3 per 100,000.

In the past year, several high-profile incidents have raised awareness of the potential danger of hidden heart anomalies and birth defects among the young and fit.

Bronny James, son of basketball legend LeBron James, suffered a sudden cardiac arrest on July 24 during basketball practice, likely caused by a congenital heart defect, according to his family.

Buffalo Bills safety Damar Hamlin experienced a cardiac arrest during a game against the Cincinnati Bengals on Jan. 2, although his heart stoppage was likely caused by a blow to the chest that disrupted his cardiac rhythm.

And Commandant of the Marine Corps^[8] Gen. Eric Smith's heart stopped beating on Oct. 29 while he was out for an afternoon run^[9], a cardiac arrest caused by a heart defect known as a bicuspid aortic valve -- a condition he was unaware he had had since birth, according to information provided by the service.

"It's been a great year for raising awareness" given that they all survived, Finlayson said.

Under the legislation, the Defense Department also is to provide a report to Congress on the results of the pilot, the rates of cardiac anomalies detected, and the cost.

The bill does not stipulate where the screenings will take place, at a MEPS or at recruit or officer training. The legislation requires only that the screenings be conducted at a DoD facility or by a military health system employee.

Finlayson said the Lion Heart Heroes Foundation would prefer they take place at MEPS so that recruits or officer candidates don't get stuck in prolonged medical holds -- referred to in 2012 by Marine Corps Times^[10] as "Parris Island^[11] purgatory."

Having a screening at a MEPS might have saved the lives of her son and others, like Andrew Adams, a Navy^[12] recruit who died of sudden cardiac arrest in 2014 at Great Lakes Training Center, Finlayson believes.

"David's death seems so pointless, but it really makes it all have meaning and makes it so he's not forgotten. It gives him a legacy," she said of her son.

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