Global cardiac screening practices among youth and adult football players: the FIFA cardiac screening survey

Objective To investigate global cardiac screening practices among elite male and female football players. Methods We surveyed all 211 FIFA Member Associations (MAs) between February and July 2024 using a 21-point questionnaire. Results A total of 165/211 (78%) MAs completed the survey. Cardiac screening was recommended or mandated by 81% (134/165) of responding MAs, with a variation between FIFA Confederations ranging from 33% (3/9 of MAs within the Oceania Football Confederation) to 100% (10/10 MAs within the South American Football Confederation). The majority of MAs use a protocol inclusive of at least medical history, physical examination and 12-lead ECG for adult male (123/134, 92%), adult female (119/134, 89%), youth male (112/134, 84%) and youth female (108/134, 81%) players. The inclusion of echocardiography was more common among adult male (91/134, 68%) and female (84/134, 63%) players compared with youth male (59/134, 44%) and youth female players (59/134, 44%). Among youth players, the age at initial cardiac screening (median age (IQR)=14 (4) years, range: 6–17 years) and the interval of serial screening were highly variable. Conclusion Routine cardiac screening is widely, but not uniformly, applied across football associations globally. There is considerable variation in cardiac screening practices based on geography and player age, suggesting that standardised global recommendations for cardiac screening in both adult and youth football are needed.