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Background Screening questionnaires typically utilize close-ended questions that consistently demonstrate low sensitivity and positive predictive value to identify individuals at risk. Furthermore, these questionnaires universally generate numerous positive responses that require on-site physician interpretation which limits cost-effectiveness and scalability.Objectives To develop and evaluate a points-based online questionnaire ( table 1), Cardiac Risk in the Young–Sports Cardiology British Columbia (CRY-BC), by comparing its performance with on-site physician review of symptoms and family history at screening.Methods Individuals completed both the standard CRY questionnaire and CRY-BC online one month prior to screening. At screening, participants underwent ECG and physician consultation. Physicians reviewed symptoms and family history from the standard questionnaire prior to on-site consultation with the screened individual and were blinded to CRY-BC results ( figure 1). Abnormal findings prompted referral for secondary cardiac evaluation. Follow-up outcomes for individuals with discordant symptom results on the CRY-BC questionnaire were obtained through telephone consultations. Receiver Operating Characteristic curve analysis was conducted to examine how varying threshold values influenced the health questionnaire performance of the CRY-BC questionnaire, including sensitivity and specificity.Results 10,570 individuals were screened (mean age 20.3 ± 6.7 years; 62% male; 39% athletes) in the UK. Fifty-six percent reported cardiovascular symptoms and/or family history on the standard questionnaire, requiring physician interpretation. When considering the symptom component of the CRY-BC alone, there was a sensitivity of 77.3%, specificity of 96.9%, and a kappa coefficient of 0.243 (95% CI 0.192–0.294, p < 0.01), indicating fair agreement. With regard to family history, the CRY-BC yielded a sensitivity of 80.0%, specificity of 99.8%, and a kappa coefficient of 0.805 (95% CI 0.746–0.864, p < 0.01), indicating almost perfect agreement ( table 1). Overall, The CRY-BC showed sensitivity 78.5%, specificity 96.7%, and κ = 0.409 (95% CI 0.351–0.467, p < 0.01), indicating moderate agreement with physician interpretation. Agreement was higher in non-athletes (κ = 0.448; moderate) than athletes (κ = 0.323; fair; z = –2.45, p < 0.05). Follow up outcomes were available for 90% of individuals with discordant symptom outcomes. Over a mean follow-up of 1.4 ± 0.4 years, no conditions associated with sudden cardiac death were identified.Conclusions The CRY-BC questionnaire performed effectively compared with on-site physician assessment. Its use may increase access to cardiac screening and generate significant cost savings, allowing more individuals with quiescent cardiac disease to be identified. This represents a potential paradigm shift in screening implementation.Abstract 274 Figure 1Outcomes pertaining to the performance of a novel points-based health questionnaire utilised in a nationwide cardiac screening programme of 10,570 young individualsAbstract 274 Table 1Table showing concordance, diagnostic performance and agreement between CRY-BC health questionnaire components and on-site physician assessment across 10,570 screened individualsComponent of CRY-BC HQTotalConcordance (%)Test performanceMeasure of agreement Sensitivity (%)Specificity (%)Kappa Cohen95% Confidence intervalp-valueLevelOverall CRY-BC 1057096.378.596.70.4090.351 – 0.467< 0.01ModerateCardiovascular symptom1057096.777.396.90.2430.192 – 0.294< 0.01FairSyncope1057097.7100.097.70.1270.074 – 0.180< 0.01SlightChest pain1057099.843.899.80.3580.166 – 0.550< 0.01FairDyspnoea1057099.9100.099.90.2850.204 – 0.316< 0.01FairPalpitation1057099.278.799.30.4590.363 – 0.555< 0.01ModerateFamily history – 1st degree1057099.680.099.80.8050.746 – 0.864< 0.01Almost perfectFamily history – 2nd degree10570100.0------Abstract 274 Table 2Performance of the cardiac risk in the young-British Columbia (CRY-BC) health questionnaire and an example questionDo you regularly experience discomfort, pain, tightness or pressure in your chest?If yes, please choose the statements that best apply to your chest pain.If no, please move to question 3PointsAIt is sharp and worsened when I take a deep breath in-3BIt usually occurs during exercise and forces me to stop+1CIt usually occurs during exercise, but it doesn’t require me to stop-1DIt Is in middle of my chest and feels heavy/dull or like a tight band+2EIt spreads into my jaw/neck or left arm+2FIt is worsened with any movement of my arms, back or chest-2GI have asthma. The chest tightness is relieved with my inhaler-2HIt can be triggered by eating or touching the area-2II get chest pain but none of the above statements apply to me*-REFER for secondary evaluation if 3 3 pointsMinimum score = 0*Automatic score of 0Total