February 18, 2020

Study reveals more footballers are suffering from heart problems – is it time for more screening?

Sudden deaths in footballers are more common than we previously believed and despite screening, cardiac conditions are still the leading cause of death in footballers. There are increasing calls made by some doctors and bereaved families for regular cardiac testing for footballers.

In recent times there have been a number of high profile deaths including Marc-Vivien Foe aged 28 and former England defender Ugo Ehiogu, who died, aged 44. However,  possibly the most well-known case of a sudden cardiac arrest is that of Fabrice Muamba who collapsed whilst playing for Bolton Wanderers. Thankfully, due to the actions of staff and a doctor at the stadium, he managed to pull through.

But why does this happen? Sudden cardiac arrest in young athletes is mostly caused by a number of factors, with the most common being:

Hypertrophic cardiomyopathy (HCM) - an inherited condition where the heart muscle walls become thick. The thickened muscle can then affect the heart’s electrical system, leading to fast or irregular heartbeats (arrhythmias) which can lead to sudden death.

Coronary artery abnormalities – sometimes people are born with coronary arteries that are connected abnormally. These arteries then become compressed during exercise and do not provide proper blood flow to the heart muscle, leading to sudden death.

Undetected congenital heart disease (present at birth)

Screening study of 11,000 Football Association players

To investigate the issues facing young footballers further, Consultant Cardiologist Dr Aneil Malhotra conducted a study that screened more than 11,000 Football Association players aged 16 for sudden cardiac death over a period of 20 years. They all had an electrical recording of the heart (ECG) and a cardiac ultrasound scan (echocardiogram).

The results were shocking.

42 individuals had cardiac diseases that could cause sudden cardiac death, having presented with hardly any symptoms prior to the test.

30 out of the 42 players had surgery or other treatment for their heart defect and were able to go back to playing football, but the other 12 stopped playing.

Eight died during exercise – six from conditions that had gone unidentified and two, who were diagnosed with HCM and were advised against competitive sport.

Should we increase the amount of cardiac testing in athletes? The worldwide debate

There is ongoing debate worldwide regarding the implementation and the extent of screening needed of athletes and their hearts.

Mandatory screening for all young adults who participated in sports has been introduced in Italy, which has resulted in an 89% reduction in sudden cardiac death. However, screening isn’t always supported and critics say that false results can lead to increased anxiety and a negative effect on well-being. There are also cost implications of carrying out further screening tests. These are the reasons why in the USA, they do not recommend this way of screening athletes. Instead, they suggest a healthcare professional go through a 14-point checklist to screen for heart disease, with a follow up only if necessary.

There is likely to be a continuing debate about whether increased screening is proven to be successful. However the study by Dr Malhotra provides evidence that early detection saves not only lives, but also sporting careers.

Our partners at British Heart Foundation view is

 “Hypertrophic Cardiomyopathy (HCM) is the most common inherited heart condition. Whilst cardiac screening amongst athletes may help detect the condition, we also stress the importance of everyone having a full awareness of their family medical history, especially if a member of the family has died suddenly under the age of 50.”

Although my view is that cardiovascular screening programmes should be a targeted and planned strategically (with focus on those who have family history) there should be regular screening for young adults who participate in sport.

In addition to screening, an increased education and awareness of cardiac arrests within the sporting field through resuscitation training and easy access to defibrillators will really help to prevent deaths both on and off the sporting field.

For more information please visit the BHF website.

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