Outcomes of cardiovascular screening in professional female football players

Objective To investigate the results of cardiac screening, prevalence of cardiac diseases and subsequent health outcomes among elite female football players in the UK. Methods Between 2000 and 2024, 3121 elite female football players underwent the English Football Association (FA) cardiac screening programme, comprising a health questionnaire, 12-lead ECG and echocardiogram. The FA registry was interrogated for screening findings, subsequent testing, diagnosis and cardiac morbidity or mortality, including sudden cardiac arrest and death (SCA/SCD). Sex-based comparisons were performed in 2680 females screened between 2017 and 2024, matched 1:2 by age, ethnicity and screening period to 5360 male players screened through the same programme. Results Female athletes were 19.8±5.4 years old, and the majority (87%) were White. Among 3121 female football players, 193 (6.2%) had an abnormal screening result requiring further evaluation; positive health questionnaires were present in 321 (10.3%), of which two (0.6%) athletes were true-positive for major cardiac conditions. Abnormal ECGs were present in 77 (2.5%), of which four (5.2%) were true positives. Major cardiac conditions were diagnosed in six (0.2%), including four with long QT syndrome, one with Wolff-Parkinson-White syndrome and one with bicuspid aortic valve with moderate to severe aortic regurgitation. No female had cardiomyopathy diagnosed at baseline; however, one (0.03%) was diagnosed with arrhythmogenic cardiomyopathy 18 months later. During 19 193 person-years of follow-up, no female experienced SCA/SCD. In matched analysis, major cardiac conditions were diagnosed in five females (0.2%) and 29 males (0.5%; p=0.027), with higher estimated screening expenditure per major diagnosis in females (£146 809 vs £51 888). Conclusions Cardiovascular screening in elite female football players identified a low prevalence of major cardiac conditions, predominantly electrical disorders, with no cardiomyopathy diagnosed at baseline and no SCA/SCD during follow-up. As female participation in elite sport continues to grow, these findings support the need for sex-appropriate interpretation and adequate budgeting for pre-participation cardiovascular evaluation.