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What you need to know when introducing Cardiac Screening for
elite athletes
Dr Sanjay Sharma
Director of
Heart Muscle Disease & Honorary Senior Lecturer, King’s College Hospital;
Medical Director for the Flora London Marathon
 The
FA, the PFA, the Football Foundation and charity Cardiac Risk in the Young
(CRY), recently launched a joint initiative which aims to raise awareness of
sudden cardiac death in the young. Hosted at Downing St by Andy Burnham MP,
Secretary of State for Culture, Media and Sport, the launch marked the start
of an initiative to highlight the opportunities for young amateur
footballers to be tested for cardiac problems.
The challenge
of screening, especially with elite young athletes, is not only the medical
procedures of ECG and ECHO, but more importantly how the results are
interpreted and the way in which the athlete is managed in light of those
results. So often this is a balance between lives and livelihoods.
I have been
CRY’s consultant cardiologist since 1995. The tremendous support of the FA,
PFA, Football Foundation and the Government is a result of the many sudden
deaths that we are all now aware of, and recognition of CRY’s initiative
introducing screening into the sporting community in 1993 and their 15 years
of experience in screening athletes.
In the UK there
are approximately 100,000 sudden cardiac deaths annually, mostly in elderly
people due to coronary artery disease and heart failure. But sometimes an
adolescent or a young individual may die suddenly and these deaths are not
infrequent.
They are far
more common than is generally understood and very costly in terms of life
years lost – a sixteen year-old person dying loses 60 to 70 years of life.
Most of these deaths are preventable. Cardiac conditions that cause death
can be identified and treatments can be instigated to prevent such
catastrophe.
The main
ambition for CRY, or the ‘goal number one’, is to identify young, apparently
healthy individuals who may unknowingly harbour cardiac conditions, with a
view to offering treatment.
CRY targeted
the athletic community after the sudden deaths of some high-profile
athletes. Initially our work was solely with the British Lawn Tennis
Association and the Football League. Subsequently we have worked with Rugby
League, British Rowing, and British Swimming. We now screen 16 or 17
national sporting disciplines. With the support of Philips Medical Systems
we are currently screening all the Olympic disciplines over the next 2
years.
In 2002 we set
up the CRY Centre for Sports Cardiology at the Olympic Medical Institute,
the first such dedicated centre for sports cardiology in the world.
Professor Greg Whyte is the Medical Director at the centre, where we provide
a service tailored to athletes when a cardiac abnormality is detected and
further tests are required to identify risks and potential implications.
However, our
full remit is wider than elite sport. We also screen families of victims of
sudden adult death syndrome at the CRY Inherited Cardiovascular Disease
Clinic at King’s College Hospital and Lewisham University Hospital. We
operate ECG testing programmes in schools such as Eton and Millfield and are
developing ECG screening clinics throughout the UK. Our programme
identifies young people with potentially very serious conditions and refers
them for treatment, including defibrillators in situ and ablations of
accessory pathways.
CRY’s screening
programme has surpassed all expectations and has fed into crucial research
for the benefit of all involved in this field. CRY was first to identify
the upper limits of wall thickness and cavity size in British athletes. We
are the first organisation in the world to characterise cardiac dimensions
in adolescent athletes – knowing how to differentiate pathology from
physiology is vital for diagnosis – and the first organisation to
characterise ECG changes in athletes in a document that is now the blueprint
for the European Society of Sport Cardiology. We are also the first
organisation to look at cardiac adaptation for Caribbean athletes, as we
know they differ from Caucasian athletes in the way they adapt to exercise.
Apart from
diagnostics and these physiological goals, CRY has also been pivotal in
identifying the prevalence of conditions such as Hypertrophic Cardiomyopathy
(HCM) in sportsmen. This includes recently identifying conditions such as
Long QT as more common than HCM. Our findings are published in reputable,
peer-reviewed journals and our guidelines are now nationally and
internationally recognised. Our vision for the next five years is now
twofold:
• To continue
the provision and development of the most proficient screening service to
elite athletes in the UK.
• To enable
people in local communities who enjoy sport, many of whom aspire to be elite
athletes, to access the very same level of expertise that we offer to
athletes representing our country and the clubs we love to support.
Being part of
the CRY screening programme is not only about identifying those at risk
through employing the highest level of cardiac expertise. It is about
taking part in a national research programme that endeavours to eliminate
young sudden cardiac death from sport and the lives of young people.
All funds
raised from CRY’s screening programme are re-invested to address the issue
of young sudden cardiac death
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