Death from cardiac disease in young football players more prevalent than previously thought

Researchers have found that silent heart conditions that cause sudden death in young athletes affect 1 in 266 football players affiliated with the English Football Association. Death rates in these young players are also three times more prevalent than previously thought. Most deaths were due to heart muscle diseases that were not detectable with screening at the age of 16. The study highlights the importance of more regular heart screenings to detect these conditions, which, in most cases, are treatable and athletes can return to competitive sport.

The study, which is the first comprehensive study into deaths caused by these inherited conditions, screened 11,168 young football players affiliated with the English Football Association over a 20-year period (1996-2016).

It found that 42 of the players (0.38%) had cardiac irregularities that can lead to heart attacks, most of who (93%) presented no symptoms. The incidence of sudden death from cardiac disease was 1 in 14,700. This compares to previous estimates, which were crudely based on media reports, search engines and insurance claims, ranging from 1 in 50,000 to 1 in 200,000.

The study was led by Sanjay Sharma, Professor of Inherited Diseases and Sports Cardiology at St George's, University of London, who is Chair of the Expert Cardiac Committee of the Football Association (FA) and Dr Aneil Malhotra, Clinical Lecturer in Cardiology.

Along with their team, they have been seeking to get an accurate picture of the numbers and causes of sudden cardiac death among adolescent soccer players in the UK, since there is no systematic registry of deaths in young athletes. Professor Sharma said:

"The death of a young athletes is highly tragic when one considers that most deaths are due to congenital/inherited diseases of the heart that are detectable during life. Affected athletes lose decades of life. Such deaths raise questions about possible preventative strategies. One of the main obstacles to implicating cardiac screening in the young is the lack of information on the precise incidence of sudden cardiac death in athletes. It is well known that adolescent athletes are most vulnerable but, before this study, nobody has ever reported outcomes in a well-defined screened cohort."

Players were tested in the FA's mandatory cardiac screening programme, which involves all youth academy players across the 92 professional clubs in the soccer league system. They were given a health questionnaire, physical exam, ECG and echocardiography. The assessments took place when young players signed their first professional contract, usually at age 16.

Where possible, the 42 athletes who were found to have cardiac conditions were medically or surgically treated and allowed to return to sport safely, others were given medical advice to stop competing. In most cases (70%) the athletes could be treated and returned to competitive sport. Forty of the players are still alive and two, who went against medical advice to stop competing, have since died.

During the study follow-up, the authors found that there had been a further six deaths from cardiac diseases due to inherited conditions that had not been picked up at the initial screening. At this time, the players were displaying normal screening results but had died an average of 6.8 years later.

This suggests that screening at 16 will miss some cardiomyopathies in predisposed individuals; and that more serial assessments may be required.

As a result of this the FA has already put serial evaluations into place at age 18 and then again at 20 and 25.
Sanjay Sharma said: "Our results represent the minimum incidence of sudden cardiac death among screened adolescent soccer players. Since we may not have captured all cases of sudden death, the death rate could be higher. On our advice the FA has now extended the screening process to protect this cohort of young athletes."