Outcomes of cardiac screening in elite para-football players in the United Kingdom

Objectives Studies to date have under-represented cardiac characteristics of para athletes, despite their unique cardiovascular physiology and risks. This study examined the cardiac electrical and structural characteristics and outcomes of pre-participation cardiac screening in elite para-football players. Methods Between 2011 and 2024, 156 consecutive para-football players underwent pre-participation evaluation comprising a health questionnaire, 12-lead ECG and echocardiogram. Players with symptoms or abnormal preliminary investigations were evaluated further, including exercise testing and cardiac MRI. Findings were compared with 1000 consecutive sex-matched and ethnicity-matched non-para-football players. Mean follow-up was 4.7±3.1 years. Results The mean age of para-football players was 21.2±5.2 years. The majority were male (71.2%) and white ethnicity (84%), followed by mixed-race (7.1%), Asian (4.5%) and Afro-Caribbean (3.8%) ethnicity. Para-football players reported cardiac symptoms more frequently and required more follow-up than non-para players (14.7% vs 6.6%; p=0.001). Para players demonstrated less sinus bradycardia (35.3% vs 44.5%; p=0.037) and a similar prevalence of abnormal T-wave inversion (1.9% vs 3.0%; p=0.622). A short PR interval was observed in 4.5% of para players compared with 0.5% of non-para players (p<0.001), although QTc intervals were similar between the two groups (402±24 ms vs 399±19 ms; p=0.138). Four (2.6%) para-football players received diagnoses associated with sudden cardiac death (SCD) versus three (0.3%) non-para players (p=0.005). Six (3.8%) para-football players were diagnosed with minor cardiovascular conditions versus 1.8% non-para players (p=0.17). In total, 10 (6.4%) para-football players were diagnosed with cardiac pathology versus 21 (2.1%) non-para-football players (p=0.005), all of whom required management or were kept under surveillance. No SCD events occurred over 4.7±3.1 years of follow-up in para-football players. Conclusion In this study, para-football players were three times more likely to be diagnosed with a cardiac condition requiring management and/or surveillance compared with non-para players. Moreover, para-football players had a higher prevalence of serious cardiac disease associated with SCD. Cardiac screening inclusive of ECG is warranted in this growing cohort of athletes.