Screening for mitral valve prolapse: an analysis of benefits and costs in the U.S. Air Force.

Using the techniques of decision analysis, several possible mitral valve prolapse screening strategies for U.S. Air Force aircrew candidates are evaluated. Available clinical and epidemiological data are organized so that the relative merits of various strategies can be assessed by decision makers. The most efficient strategy is to screen pilot candidates with Quetelet's index (weight in kilograms/height in meters squared) and then eliminate those with an index at or below 15 who have an echocardiogram positive for mitral valve prolapse. The next most efficient strategy is to do echocardiograms on candidates with a heart murmur or click. Screening all candidates with an echocardiogram is much less efficient. Screening fighter pilot candidates only is a very inefficient strategy. Available data do not make a very convincing case for any screening program. Concerned and informed physicians will continue to have honest disagreements about screening for mitral valve prolapse in aircrew members.