In the Journals

Mandated health screenings for footballers may miss signs of CV incidents

Mandated health screenings for European football players may not always catch the potential for CV incidents, according to a study published in the British Journal of Sports Medicine.

The findings were the result of an 8-year follow-up of preparticipation screenings of 604 male professional football players from 28 of the 30 teams in the Norwegian elite and first-division leagues between February and April 2008. The study’s objective was to identify CV incidents in the cohort that was cleared to play after a negative screening result.

The screenings, which are mandated by the Union of European Football Associations (UEFA) and conducted in La Manga, Spain, included examinations of BP measurements, symptoms related to CVD during sport, family history of CVD, and ECG and echocardiography, as mandated by UEFA and the International Federation of Association Football (FIFA), the governing body for international soccer competition.

Severe incidents

“The number of severe incidents was remarkably higher than expected in this young population. We have no explanation for this; it could simply represent a random effect due to small numbers,” Hilde Moseby Berge, MD, from the department of sports medicine at Oslo Sports Trauma Research Center, Norwegian School of Sport Sciences, and colleagues wrote.

Of the players screened, 98.5% agreed to participate in the screening (aged 18-40 years; 504 white; 49 black; 42 other ethnicity). Of the players assessed, 94.6% had negative results, whereas 5.4% had a positive screening result. Of those with a positive result, two had stage 2 hypertension and left ventricular hypertrophy on echocardiography and were not cleared on-site but were later cleared after receiving appropriate treatment. The others were cleared to play, but further investigations were recommended.

Many of the initial ECGs were re-examined several weeks later.

CV concerns

During follow-up, six players (1%; all white) experienced CV incidents during the 8-year period of screening after a median of 41 months (range, 16-53), with three players having sudden cardiac arrests. All were successfully resuscitated, two through the use of automated external defibrillators. The other three players had MI, atrial flutter and transient ischemic attack.

All six players had normal BMI, BP and heart rate during the screening and had negative results during both the on-site and second cardiologist reviews. Clinical notes showed three of the players ignored symptoms, including chest pains, paresis, dyspnea or near-syncope, with two completing their respective matches before seeking medical assistance. The review also showed that appropriate treatment was delayed after physician and hospital presentation in three cases, whereas in two cases, patients who presented with serious symptoms were discharged without proper follow-up, and one case, the symptoms were misinterpreted.

The researchers wrote that standard cardiac screenings as used in the sport setting are designed to capture some, but not all, cardiac problems, noting the examinations are mainly expected to detect inherited ion channel diseases, electrical accessory pathways, manifestation of cardiomyopathy, aortopathy and congenital valvular or septal defects.

“It is important to remind athletes that a normal screening does not protect against all cardiac disease and that timely reporting of symptoms is essential,” Berge and colleagues wrote. – by Earl Holland

Disclosures: The authors report no relevant financial disclosures.

Mandated health screenings for European football players may not always catch the potential for CV incidents, according to a study published in the British Journal of Sports Medicine.

The findings were the result of an 8-year follow-up of preparticipation screenings of 604 male professional football players from 28 of the 30 teams in the Norwegian elite and first-division leagues between February and April 2008. The study’s objective was to identify CV incidents in the cohort that was cleared to play after a negative screening result.

The screenings, which are mandated by the Union of European Football Associations (UEFA) and conducted in La Manga, Spain, included examinations of BP measurements, symptoms related to CVD during sport, family history of CVD, and ECG and echocardiography, as mandated by UEFA and the International Federation of Association Football (FIFA), the governing body for international soccer competition.

Severe incidents

“The number of severe incidents was remarkably higher than expected in this young population. We have no explanation for this; it could simply represent a random effect due to small numbers,” Hilde Moseby Berge, MD, from the department of sports medicine at Oslo Sports Trauma Research Center, Norwegian School of Sport Sciences, and colleagues wrote.

Of the players screened, 98.5% agreed to participate in the screening (aged 18-40 years; 504 white; 49 black; 42 other ethnicity). Of the players assessed, 94.6% had negative results, whereas 5.4% had a positive screening result. Of those with a positive result, two had stage 2 hypertension and left ventricular hypertrophy on echocardiography and were not cleared on-site but were later cleared after receiving appropriate treatment. The others were cleared to play, but further investigations were recommended.

Many of the initial ECGs were re-examined several weeks later.

CV concerns

During follow-up, six players (1%; all white) experienced CV incidents during the 8-year period of screening after a median of 41 months (range, 16-53), with three players having sudden cardiac arrests. All were successfully resuscitated, two through the use of automated external defibrillators. The other three players had MI, atrial flutter and transient ischemic attack.

All six players had normal BMI, BP and heart rate during the screening and had negative results during both the on-site and second cardiologist reviews. Clinical notes showed three of the players ignored symptoms, including chest pains, paresis, dyspnea or near-syncope, with two completing their respective matches before seeking medical assistance. The review also showed that appropriate treatment was delayed after physician and hospital presentation in three cases, whereas in two cases, patients who presented with serious symptoms were discharged without proper follow-up, and one case, the symptoms were misinterpreted.

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The researchers wrote that standard cardiac screenings as used in the sport setting are designed to capture some, but not all, cardiac problems, noting the examinations are mainly expected to detect inherited ion channel diseases, electrical accessory pathways, manifestation of cardiomyopathy, aortopathy and congenital valvular or septal defects.

“It is important to remind athletes that a normal screening does not protect against all cardiac disease and that timely reporting of symptoms is essential,” Berge and colleagues wrote. – by Earl Holland

Disclosures: The authors report no relevant financial disclosures.