Pre-competition cardiac assessments do not identify all players at risk

The purpose of a pre-competition cardiac assessment is to detect cardiovascular disease at an early stage and to prevent sudden cardiac arrests and deaths. There is currently limited data on the cardiovascular outcomes for players classified as ‘being normal’ during this assessment. The objective of the paper included in this FastFact was to identify cardiovascular incidents in a cohort of male professional football players who were cleared to play after a negative assessment1.

This retrospective follow-up included 595 professional male football players in Norway who underwent a preparticipation cardiac assessment. This assessment was done in 2008 by experienced cardiologists and including electrocardiography (ECG) and echocardiography. A media search was performed to identify sudden cardiovascular incidents between January 2008 and February 2016 with any incidents being cross-checked with medical records. Six of the 595 players (1%), all classified as negative during their assessment, experienced severe cardiovascular incidents during follow-up. A retrospective review revealed abnormal ECG findings in one case that was not identified. Three players suffered a sudden cardiac arrest (all resuscitated successfully), one a myocardial infarction, one a transient ischaemic attack and one atrial flutter. Three of the players ignored chest pain, paresis, dyspnoea or near-syncope, two completed a match with symptoms before seeking medical assistance, one player’s symptoms were misinterpreted and received inappropriate treatment initially, and two players were discharged from hospital without proper follow-up, despite having serious cardiovascular symptoms.

A comprehensive pre-participation cardiac assessment did not identify six players who experienced subsequent cardiovascular incidents. Standard assessment protocols are designed to capture some, but not all, heart problems, and are often one-off events, so health might have deteriorated during the interim in the six players–something which a repeat assessment may have identified. The results of this study highlight that it is important to remind players (their families and their medical staff) that a normal cardiac assessment does not protect against all cardiac diseases and that timely reporting of symptoms is essential. Prompt treatment was delayed in three cases, because doctors either misinterpreted symptoms or discharged patients with serious symptoms without appropriate monitoring. This underscores the need for ongoing clinical vigilance (treat the patient in front of you) as well as training in the use of readily available automated external defibrillators (AEDs). A comprehensive medical emergency plan, including AEDs, should be available in all training and competition facilities.

To read more about pre-competition assessments complete the PCMA module in the FIFA Diploma in Football Medicine.

Reference
1. Berge HM, Andersen TE, Bahr R. Cardiovascular incidents in male professional football players with negative preparticipation cardiac screening results: an 8- year follow-up Br J Sports Med 2019;53:1279–1284. doi:10.1136/bjsports-2018- 099845

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berejena
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berejena

Is there room for periodic cardiac assessment in professional players and if so, after how long?

Mark Fulcher
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Hi Berejena. Have a look at the PCMA module. You will be able to see what FC Barcelona does. A common regime is to repeat the cardiac assessment every two years, possibly more frequently for younger players. Data from Aspetar suggests that the best regime is a clinical assessment, ECG and an echocardiogram/other investigations when an abnormality is found. Many professional clubs do include an echo in their routine assessment. I believe that the English Leagues require an echocardiogram at least once in a player’s career.

Phillip Jan Rammego
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Phillip Jan Rammego

Doc, does a periodic cardiac assessment every two years apply the same to players who have, actually, predisposed cardiac diseases?

Bangoura
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Bangoura

LA FIFA MET DE TRES GROS MOYENS POUR PRESERVER LA VIE DES SPOTIFS SUR LE PLAN MEDICAL.UN PCMA(EXAMENS PRE.COMPETITIONS) OBLIGATOIRES POUR TOUS LES SPORTIFS LORS DES PHASES FINALES DES COMPETITIONS MONDIALES ET CONTINENTALES .L ECG ET L ECHO DOPPLER CARDIAQUE POUR DECELER LA MOINDRE ANOMALIE CARDIO VASCULAIRE. MALGRE TOUS CES GROS MOYENS EN MATIERE DE HAUTE TECHNOLOGIE NOUS RENCONTRONS ENCORE DES CAS DE MORT SUBITE. AU NIVEAU DES CLUBS DES EXAMENS CARDIO VASCULAIRE S AVANT ET PENDANT LES COMPETITIONS SONT RENDUS OBLIGATOIRE POUR DETECTER LE MOINDRE INDICE EN MATIERE DE PATHOLOGIE CARDIO VASCULAIRE LA QUESTION QU ON SE POSE POURQUOI… Read more »