Key result
Preparticipation cardiac screening did not identify a subset of 6 of 595 (1%) male professional football players who experienced severe cardiovascular incidents during an 8-year follow-up.
Why the study?
Preparticipation cardiac screening aims to prevent sudden cardiac arrest and death, but few studies have described cardiovascular outcomes in athletes classified as negative on screening.
Does a negative preparticipation cardiac screening guarantee the absence of future severe cardiovascular incidents in professional male football players?
Cohort (n=595)
Does a negative preparticipation cardiac screening guarantee the absence of future severe cardiovascular incidents in professional male football players?
A normal preparticipation cardiac screening does not protect against all cardiac diseases, as 1% of screened-negative professional football players experienced severe cardiovascular incidents over 8 years, highlighting the importance of symptom reporting.
Negative preparticipation screening does not eliminate incident risk; leaves open need for symptom vigilance and refined surveillance in screened athletes.
BACKGROUND: Preparticipation cardiac screening of athletes aims to detect cardiovascular disease at an early stage to prevent sudden cardiac arrests and deaths. Few studies have described the cardiovascular outcomes in athletes classified as negative on screening. OBJECTIVE: To identify cardiovascular incidents in a cohort of male professional football players who were cleared to play after a negative screening result. METHODS: This is a retrospective 8-year follow-up study of 595 professional male football players in Norway who underwent preparticipation cardiac screening by experienced cardiologists, including electrocardiography (ECG) and echocardiography, in 2008. We performed a media search to identify sudden cardiovascular incidents between January 2008 and February 2016. Incidents were cross-checked with medical records. RESULTS: Six of the 595 players (1%), all classified as negative on cardiac screening, experienced severe cardiovascular incidents during follow-up. Retrospective review revealed abnormal ECG findings in one case, not recognised at the time of screening. 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. CONCLUSIONS: A comprehensive preparticipation cardiac screening did not identify a subset of 6 of 595 players who experienced subsequent cardiovascular incidents as being at risk. It is important to remind athletes that a normal cardiac screening exam does not protect against all cardiac diseases. Timely reporting of symptoms is essential.
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Berge et al. (2018) conducted a cohort in Cardiovascular incidents in athletes (n=595). Preparticipation cardiac screening was evaluated on Severe cardiovascular incidents. Preparticipation cardiac screening did not identify a subset of 6 of 595 (1%) male professional football players who experienced severe cardiovascular incidents during an 8-year follow-up.
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