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D'Ascenzi F, Ragazzoni GL, Boncompagni A, Cavigli L. Sports cardiology: A glorious past, a well-defined present, a bright future. Clin Cardiol 2023; 46:1015-1020. [PMID: 37503665 PMCID: PMC10540010 DOI: 10.1002/clc.24112] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 07/21/2023] [Accepted: 07/27/2023] [Indexed: 07/29/2023] Open
Abstract
The attention towards sports cardiology has dramatically grown after the introduction of preparticipation screening and the need for specific education on electrocardiogram interpretation in athletes, given the differences between athletes and the general population. The present article stresses the need for specific skills, knowledge, and clinical expertise in sports cardiology, which are essential for appropriately screening competitive athletes to prevent sudden cardiac death and avoid overdiagnosis. However, disqualification from sports competitions may lead to sports inactivity, and athletes may enter a gray zone where little or no information is provided about what they can or cannot do to stay active. However, modern sports cardiology cannot neglect the patient's needs and the importance of the safe practice of regular exercise. In this context, the personalized exercise prescription plays a crucial role in the core curriculum and the clinical activity of professionals involved in sports cardiology programs. Given its specificities, sports cardiology requires a formal education plan for medical school students and all residents. Additional education and practice are required for young colleagues who want to focus their professional lives on sports cardiology. The future directions of emerging modern sports cardiology should not neglect the importance of a scientific community that works together, designing multicenter international outcomes-based research to address the many remaining areas of uncertainty.
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Affiliation(s)
- Flavio D'Ascenzi
- Department of Medical Biotechnologies, Division of CardiologyUniversity of SienaSienaItaly
| | - Gian L. Ragazzoni
- Department of Medical Biotechnologies, Division of CardiologyUniversity of SienaSienaItaly
| | - Alex Boncompagni
- Department of Medical Biotechnologies, Division of CardiologyUniversity of SienaSienaItaly
| | - Luna Cavigli
- Department of Medical Biotechnologies, Division of CardiologyUniversity of SienaSienaItaly
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2
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Jiravska Godula B, Jiravsky O, Pesova P, Jelinek L, Sovova M, Moravcova K, Ozana J, Hudec M, Miklik R, Hecko J, Sknouril L, Sovova E. Preparticipation Screening of Athletes: The Prevalence of Positive Family History. J Cardiovasc Dev Dis 2023; 10:jcdd10040183. [PMID: 37103062 PMCID: PMC10144243 DOI: 10.3390/jcdd10040183] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 04/08/2023] [Accepted: 04/19/2023] [Indexed: 04/28/2023] Open
Abstract
Sudden cardiac death (SCD) is a leading cause of death among athletes, and those with a positive family history (FH) of SCD and/or cardiovascular disease (CVD) may be at increased risk. The primary objective of this study was to assess the prevalence and predictors of positive FH of SCD and CVD in athletes using four widely used preparticipation screening (PPS) systems. The secondary objective was to compare the functionality of the screening systems. In a cohort of 13,876 athletes, 1.28% had a positive FH in at least one PPS system. Multivariate logistic regression analysis identified the maximum heart rate as significantly associated with positive FH (OR = 1.042, 95% CI = 1.027-1.056, p < 0.001). The highest prevalence of positive FH was found using the PPE-4 system (1.20%), followed by FIFA, AHA, and IOC systems (1.11%, 0.89%, and 0.71%, respectively). In conclusion, the prevalence of positive FH for SCD and CVD in Czech athletes was found to be 1.28%. Furthermore, positive FH was associated with a higher maximum heart rate at the peak of the exercise test. The findings of this study revealed significant differences in detection rates between PPS protocols, so further research is needed to determine the optimal method of FH collection.
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Affiliation(s)
- Bogna Jiravska Godula
- Faculty of Medicine, Palacky University, Krizkovskeho 511/8, 779 00 Olomouc, Czech Republic
- Sports Cardiology Center, Nemocnice Agel Trinec-Podlesi, Konska 453, 739 61 Trinec, Czech Republic
| | - Otakar Jiravsky
- Sports Cardiology Center, Nemocnice Agel Trinec-Podlesi, Konska 453, 739 61 Trinec, Czech Republic
- Faculty of Medicine, Masaryk University, Kamenice 735/5, 625 00 Brno, Czech Republic
| | - Petra Pesova
- Faculty of Medicine, Palacky University, Krizkovskeho 511/8, 779 00 Olomouc, Czech Republic
- Sports Cardiology Center, Nemocnice Agel Trinec-Podlesi, Konska 453, 739 61 Trinec, Czech Republic
| | - Libor Jelinek
- Faculty of Medicine, Palacky University, Krizkovskeho 511/8, 779 00 Olomouc, Czech Republic
| | - Marketa Sovova
- Faculty of Medicine, Palacky University, Krizkovskeho 511/8, 779 00 Olomouc, Czech Republic
| | - Katarina Moravcova
- Faculty of Medicine, Palacky University, Krizkovskeho 511/8, 779 00 Olomouc, Czech Republic
| | - Jaromir Ozana
- Faculty of Medicine, Palacky University, Krizkovskeho 511/8, 779 00 Olomouc, Czech Republic
| | - Miroslav Hudec
- Sports Cardiology Center, Nemocnice Agel Trinec-Podlesi, Konska 453, 739 61 Trinec, Czech Republic
- Faculty of Medicine, Masaryk University, Kamenice 735/5, 625 00 Brno, Czech Republic
| | - Roman Miklik
- Sports Cardiology Center, Nemocnice Agel Trinec-Podlesi, Konska 453, 739 61 Trinec, Czech Republic
- Faculty of Medicine, Masaryk University, Kamenice 735/5, 625 00 Brno, Czech Republic
| | - Jan Hecko
- Sports Cardiology Center, Nemocnice Agel Trinec-Podlesi, Konska 453, 739 61 Trinec, Czech Republic
- Faculty of Electrical Engineering and Computer Science, VSB-Technical University of Ostrava, 708 33 Ostrava, Czech Republic
| | - Libor Sknouril
- Sports Cardiology Center, Nemocnice Agel Trinec-Podlesi, Konska 453, 739 61 Trinec, Czech Republic
| | - Eliska Sovova
- Faculty of Medicine, Palacky University, Krizkovskeho 511/8, 779 00 Olomouc, Czech Republic
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Safar Cherati A, Khalifeh Soltani S, Moghadam N, Hassanmirzaei B, Haratian Z, Khalifeh Soltani S, Rezaei M. Is there a relationship between lower-extremity injuries and foot postures in professional football players? A prospective cohort study. SCI MED FOOTBALL 2022; 6:49-59. [PMID: 35236229 DOI: 10.1080/24733938.2020.1870711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Lower extremity injuries are an ongoing concern for professional football players. This study aims to evaluate the relationship between foot posture and lower extremity injuries in professional football players. METHOD In this prospective cohort study, 420 male players of the Iran Premium football league were evaluated during the 2015-2016 season. The players were assessed for their foot types based on optical and static foot scans and foot posture index (FPI). The trained club physicians recorded all injuries during the season. RESULT The analyzed data of 244 players showed the highest rate of lower extremity injury in hamstrings, ankle, and groin, respectively. These injuries led to 46% of time loss. The probability of hamstrings injuries was higher among pronated players based on static, optic, FPI, and visual examination, 2.1, 1.8, 1.8, and 2.3, respectively. Medial Collateral Ligament (MCL) injuries were associated with subtalar joint abnormality defined by visual observation. An increased relative risk of leading-to-absence injuries among the flat foot group was significant based on optic scanning, FPI, and visual observation. CONCLUSION Abnormal foot postures in professional football players may increase the risk of hamstring and MCL injuries and time loss due to lower extremity injuries.
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Affiliation(s)
- Afsaneh Safar Cherati
- Department of Sport and Exercise Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Salman Khalifeh Soltani
- Department of Sport and Exercise Medicine, Iran University of Medical Sciences, Tehran, Iran.,Iran Football Medical Assessment and Rehabilitation Center - IFMARC, Tehran, Iran
| | - Navid Moghadam
- Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Bahar Hassanmirzaei
- Iran Football Medical Assessment and Rehabilitation Center - IFMARC, Tehran, Iran.,Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Zohreh Haratian
- Iran Football Medical Assessment and Rehabilitation Center - IFMARC, Tehran, Iran
| | | | - Meisam Rezaei
- Department of Sport and Exercise Medicine, Iran University of Medical Sciences, Tehran, Iran
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Pi-Rusiñol R, Sanz-de la Garza M, Grazioli G, García M, Sitges M, Drobnic F. Pre-participation medical evaluation in competitive athletes: the experience of an international multisport club. APUNTS SPORTS MEDICINE 2022. [DOI: 10.1016/j.apunsm.2021.100369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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5
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MacLachlan H, Dhutia H, Bhatia R, Boden K, Forenc K, Basu J, Miles C, Osborne R, Chandra N, Malhotra A, Stuart G, Peirce N, Sharma S, Papadakis M. Results of a nationally implemented cardiac screening programme in elite cricket players in England and Wales. J Sci Med Sport 2021; 25:287-292. [PMID: 35016820 DOI: 10.1016/j.jsams.2021.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 11/30/2021] [Accepted: 12/05/2021] [Indexed: 01/02/2023]
Abstract
OBJECTIVES We assessed the diagnostic yield and costs of an electrocardiogram-based national screening programme in elite cricket players and the incremental value of transthoracic echocardiography and periodic evaluation. DESIGN Cross-sectional study. METHODS Between 2008 and 2019, 1208 cricketers underwent screening with a health questionnaire, 12-lead electrocardiogram and cardiology consultation. Athletes with concerning findings underwent on-site transthoracic echocardiography and further investigations as necessary. In addition, despite a normal health questionnaire and electrocardiogram, 342 (28.3%) athletes had a transthoracic echocardiogram and 493 (40.8%) underwent repeat evaluations. RESULTS After initial evaluation, 47 (3.9%) athletes underwent on-site transthoracic echocardiography of whom 35 (2.8%) were referred for further evaluation. Four athletes (0.3%) were diagnosed with major cardiac conditions; hypertrophic cardiomyopathy (n = 1), arrhythmogenic cardiomyopathy (n = 1) and Wolff-Parkinson-White pattern (n = 2). Two athletes were identified with minor valvular abnormalities. Repeat evaluation of 493 athletes identified hypertrophic cardiomyopathy in a 22-year-old athlete, two years after his initial normal screening. During a follow-up of 5.8 ± 2.9 years no additional diagnoses or adverse cardiac events were reported. The cost of the electrocardiogram-based programme was £127,844, translating to £106 per athlete and £25,569 per major cardiac condition identified.Routine transthoracic echocardiography in 342 athletes identified two athletes with major cardiac conditions (bicuspid aortic valve with severe aortopathy and aortic regurgitation and an atrial septal defect associated with right ventricular volume overload) and 10 athletes with minor abnormalities. CONCLUSIONS An electrocardiogram-based national screening programme identified a major cardiac condition in 0.3% of athletes. Routine transthoracic echocardiography and periodic evaluation increased the diagnostic yield to 0.6%, at an incremental cost.
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Affiliation(s)
- H MacLachlan
- Cardiovascular Clinical Academic Group, St Georges, University of London, United Kingdom
| | - H Dhutia
- Department of Cardiology, Glenfield Hospital, United Kingdom
| | - R Bhatia
- Cardiovascular Clinical Academic Group, St Georges, University of London, United Kingdom
| | - K Boden
- England and Wales Cricket Board and National Centre for Sports and Exercise Medicine and National Cricket Performance Centre, Loughborough University, United Kingdom
| | - K Forenc
- Cardiovascular Clinical Academic Group, St Georges, University of London, United Kingdom
| | - J Basu
- Cardiovascular Clinical Academic Group, St Georges, University of London, United Kingdom
| | - C Miles
- Cardiovascular Clinical Academic Group, St Georges, University of London, United Kingdom
| | - R Osborne
- Cardiac Risk in the Young, United Kingdom
| | - N Chandra
- Department of Cardiology, Frimley Park Hospital, United Kingdom
| | - A Malhotra
- Division of Cardiovascular Sciences, University of Manchester, United Kingdom
| | - G Stuart
- National Institute of Health Research Cardiovascular Biomedical Research Centre, Bristol Heart Institute, United Kingdom
| | - N Peirce
- England and Wales Cricket Board and National Centre for Sports and Exercise Medicine and National Cricket Performance Centre, Loughborough University, United Kingdom
| | - S Sharma
- Cardiovascular Clinical Academic Group, St Georges, University of London, United Kingdom
| | - M Papadakis
- Cardiovascular Clinical Academic Group, St Georges, University of London, United Kingdom.
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Ousaka D, Hirai K, Sakano N, Morita M, Haruna M, Hirano K, Yamane T, Teraoka A, Sanou K, Oozawa S, Kasahara S. Initial evaluation of a novel electrocardiography sensor-embedded fabric wear during a full marathon. Heart Vessels 2021; 37:443-450. [PMID: 34519873 PMCID: PMC8438904 DOI: 10.1007/s00380-021-01939-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 09/03/2021] [Indexed: 10/27/2022]
Abstract
Sudden cardiac accident (SCA) during a marathon is a concern due to the popularity of the sport. Preventive strategies, such as cardiac screening and deployment of automated external defibrillators have controversial cost-effectiveness. We investigated the feasibility of use of a new electrocardiography (ECG) sensor-embedded fabric wear (SFW) during a marathon as a novel preventive strategy against SCA. Twenty healthy volunteers participated in a full marathon race. They were equipped with a SFW hitoe® with a transmitter connected via Bluetooth to a standard smartphone for continuous ECG recording. All data were stored in a smartphone and used to analyze the data acquisition rate. The adequate data acquisition rate was > 90% in 13, 30-90% in 3, and < 10% in 4 runners. All of 4 runners with poorly recorded data were female. Inadequate data acquisition was significantly associated with the early phase of the race compared with the mid phase (P = 0.007). Except for 3 runners with poor heart rate data, automated software calculation was significantly associated with manual analysis for both the mean (P < 0.001) and maximum (P = 0.014) heart rate. We tested the feasibility of continuously recording cardiac data during a marathon using a new ECG sensor-embedded wearable device. Although data from 65% of runners were adequately recorded, female runners and the early phase of the race tended to have poor data acquisition. Further improvements in device ergonomics and software are necessary to improve ability to detect abnormal ECGs that may precede SCA.
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Affiliation(s)
- Daiki Ousaka
- Department of Pharmacology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, Okayama, 700-8558, Japan
| | - Kenta Hirai
- Department of Pediatric Cardiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, Okayama, 700-8558, Japan
| | - Noriko Sakano
- Department of Biomedical Informatics, Okayama University Graduate School of Interdisciplinary Science and Engineering in Health Systems, Okayama, 700-8558, Japan
| | - Mizuki Morita
- Department of Biomedical Informatics, Okayama University Graduate School of Interdisciplinary Science and Engineering in Health Systems, Okayama, 700-8558, Japan
| | - Madoka Haruna
- Department of Clinical Laboratory, Okayama University Hospital, Okayama, 700-8558, Japan
| | - Kazuya Hirano
- Department of Biomedical Informatics, Okayama University Graduate School of Interdisciplinary Science and Engineering in Health Systems, Okayama, 700-8558, Japan
| | - Takahiro Yamane
- Department of Biomedical Informatics, Okayama University Graduate School of Interdisciplinary Science and Engineering in Health Systems, Okayama, 700-8558, Japan
| | - Akira Teraoka
- Teraoka Memorial Hospital, Hiroshima, 729-3103, Japan
| | | | - Susumu Oozawa
- Department of Clinical Safety, Okayama University Hospital, Okayama, 700-8558, Japan
| | - Shingo Kasahara
- Department of Cardiovascular Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, Okayama, 700-8558, Japan.
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Austin AV, Owens DS, Prutkin JM, Salerno JC, Ko B, Pelto HF, Rao AL, Siebert DM, Carrol JS, Harmon KG, Drezner JA. Do 'pathologic' cardiac murmurs in adolescents identify structural heart disease? An evaluation of 15 141 active adolescents for conditions that put them at risk of sudden cardiac death. Br J Sports Med 2021; 56:88-94. [PMID: 33451997 DOI: 10.1136/bjsports-2019-101718] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2020] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We assessed whether the presence and character of a cardiac murmur in adolescents were associated with structural heart disease that confers risk of sudden cardiac death (SCD). METHODS We performed a retrospective analysis of 15 141 adolescents age 12-19 who underwent a heart screen with history, physical examination and ECG. Participants with any screening abnormality underwent an echocardiogram for the assessment of structural heart disease. Murmurs were classified as physiological or pathological according to standard clinical criteria, and participants with murmurs were compared with a comparison group without murmurs. The primary outcome was echocardiogram-detected structural heart disease associated with SCD. RESULTS 905 participants with a cardiac murmur (mean age 15.8; 58% male) and 4333 participants without a murmur (comparison group; mean age 15.8; 55% male) had an echocardiogram to detect structural heart disease. 743 (82%) murmurs were described as physiological and 162 (18%) as pathological. Twenty-five (2.8%) participants with murmurs and 61 (1.4%) participants without murmurs had structural heart disease. Three (0.3%) participants in the murmur group were diagnosed with hypertrophic cardiomyopathy (HCM) which was the only identified condition associated with SCD. Two participants with HCM had physiological murmurs, one had a pathological murmur, and all three had an abnormal ECG. The most common minor structural heart disease was bicuspid aortic valve in both the murmur (7; 0.8%) and comparison (20; 0.5%) groups. The positive predictive value of physiological versus pathological murmurs for identifying any structural heart disease was 2.4% versus 4.3% (p=0.21), respectively. The positive predictive value of having any murmur versus no murmur for identifying structural heart disease was 2.8% versus 1.4% (p=0.003), respectively. CONCLUSIONS In adolescents, the traditional classification of cardiac murmurs as 'physiologic' or 'pathologic' does not differentiate for structural heart disease that puts individuals at risk for SCD. We recommend ECG evaluation in all patients with a cardiac murmur found during preparticipation screening to increase detection of HCM.
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Affiliation(s)
- Ashley V Austin
- Department of Family Medicine, Sports Medicine Section, University of Washington, Seattle, Washington, USA
| | - David S Owens
- Department of Internal Medicine, Division of Cardiology, University of Washington, Seattle, Washington, USA
| | - Jordan M Prutkin
- Department of Internal Medicine, Division of Cardiology, University of Washington, Seattle, Washington, USA
| | - Jack C Salerno
- Division of Cardiology, Seattle Children's Hospital, Seattle, Washington, USA
| | - Brian Ko
- School of Medicine, University of Washington, Seattle, Washington, USA
| | - Hank F Pelto
- Department of Family Medicine, Sports Medicine Section, University of Washington, Seattle, Washington, USA
| | - Ashwin L Rao
- Department of Family Medicine, Sports Medicine Section, University of Washington, Seattle, Washington, USA
| | - David M Siebert
- Department of Family Medicine, Sports Medicine Section, University of Washington, Seattle, Washington, USA
| | - Jennifer S Carrol
- Department of Family Medicine, Sports Medicine Section, University of Washington, Seattle, Washington, USA
| | - Kimberly G Harmon
- Department of Family Medicine, Sports Medicine Section, University of Washington, Seattle, Washington, USA
| | - Jonathan A Drezner
- Department of Family Medicine, Sports Medicine Section, University of Washington, Seattle, Washington, USA
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8
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Abela M, Sharma S. Electrocardiographic interpretation in athletes. Minerva Cardiol Angiol 2020; 69:533-556. [PMID: 33059398 DOI: 10.23736/s2724-5683.20.05331-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Participation in regular exercise of moderate intensity is associated with a plethora of systemic benefits, including a reduction in risk factors for coronary atherosclerosis; however, intensive exercise may paradoxically culminate in sudden cardiac arrest among individuals harboring arrhythmogenic substrates. The precise mechanism for arrhythmogenesis is likely multifactorial, however, surges in catecholamines, electrolyte shifts, acid-base disturbances, increased core temperature and demand myocardial ischemia are potential contributors. Although most deaths occur in middle aged and older males with atherosclerotic coronary artery disease, a significant proportion also affect young athletes with inherited or congenital cardiac abnormalities. The impact of such catastrophes on society, particularly when a young high-profile athlete is affected could be considered a justified reason for identifying individuals who may be at risk. Given the rarity of deaths in young athletes, only the simplest screening test, such as the 12-lead electrocardiography (ECG) may be considered to be cost effective. The ECG is effective for detecting serious electrical diseases in young athletes such as congenital electrical accessory pathways and ion channel diseases but can also identify athletes with potential life-threatening structural diseases such as hypertrophic and arrhythmogenic cardiomyopathy. One of the concerns about ECG screening is that regular intensive exercise results in several physiological alterations in cardiac structure and function that are reflected on the athlete's ECG. Sinus bradycardia, first-degree atrioventricular block, incomplete right bundle branch block, minor J-point elevation and large QRS voltages are common. Conversely, some repolarization anomalies affecting the ST segment, T waves and QT interval may overlap with patterns observed in patients with serious cardiac diseases. The situation is complicated further because age, sex and ethnicity of the athletes also influence the ECG and there is a risk that erroneous interpretation could have serious consequences. This review will describe the normal electrical patterns of the "athlete's heart" and provide insights into differentiation physiological electrical patterns from those observed in serious cardiac disease.
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Affiliation(s)
- Mark Abela
- Department of Cardiology, Mater Dei Hospital, Msida, Malta - .,Malta Medical School, University of Malta, Msida, Malta - .,St. George's University Hospitals, NHS Foundation Trust, St George's University, London, UK -
| | - Sanjay Sharma
- St. George's University Hospitals, NHS Foundation Trust, St George's University, London, UK
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9
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Nabhan D, Lewis M, Taylor D, Bahr R. Expanding the screening toolbox to promote athlete health: how the US Olympic & Paralympic Committee screened for health problems in 940 elite athletes. Br J Sports Med 2020; 55:226-230. [PMID: 33020138 DOI: 10.1136/bjsports-2020-102756] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2020] [Indexed: 11/04/2022]
Abstract
AIM To assess the value of including validated screening tools for allergies, anxiety, depression, sleep apnoea and sleep quality into an electronic patient health history questionnaire. METHODS In this descriptive study, we reviewed electronic medical records of Olympic and Paralympic athletes who completed health screenings, which included validated screens for allergies (Allergy Questionnaire for Athletes), anxiety (General Anxiety Disorder-2), depression (Patient Health Questionaire-2), sleep apnoea (Berlin Questionnaire) and sleep quality (Pittsburgh Sleep Quality Index), using established criteria for a positive screen. We report the prevalence of positive tests and the associations between positive screening tools. RESULTS A total of 683 Olympic and 257 Paralympic athletes (462 male, 478 female) completed the health history between May and September of 2019. At least one positive screen was reported by 37% of athletes training for the Olympics and 48% of athletes training for the Paralympics. More than 20% of all athletes screened positive for allergies and poor sleep quality. Athletes training for the Paralympics had a significantly higher percentage of positive screens for anxiety, depression, poor sleep quality and sleep apnoea risk. Females had significantly more positive screens for allergy and poor sleep quality. CONCLUSIONS The addition of standardised screening tools to an electronic health history resulted in the identification of potential mental health, sleep and allergy problems in both Olympic and Paralympic athletes. Strong associations between mental health and sleep disorders suggest these problems should be considered together in health screening programmes.
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Affiliation(s)
- Dustin Nabhan
- Sports Medicine, United States Olymic & Paralympic Committee, Colorado Springs, Colorado, USA .,US Coalition for the Prevention of Illness and Injury in Sport, Colorado Springs, Colorado, USA
| | - Melie Lewis
- Sports Medicine, United States Olymic & Paralympic Committee, Colorado Springs, Colorado, USA.,US Coalition for the Prevention of Illness and Injury in Sport, Colorado Springs, Colorado, USA
| | - David Taylor
- Sports Medicine, United States Olymic & Paralympic Committee, Colorado Springs, Colorado, USA.,US Coalition for the Prevention of Illness and Injury in Sport, Colorado Springs, Colorado, USA
| | - Roald Bahr
- Oslo Sports Trauma Research Center, Oslo, Norway
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Dhutia H, MacLachlan H. Cardiac Screening of Young Athletes: a Practical Approach to Sudden Cardiac Death Prevention. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2018; 20:85. [PMID: 30155696 PMCID: PMC6132782 DOI: 10.1007/s11936-018-0681-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
PURPOSE OF REVIEW We aim to report on the current status of cardiovascular screening of athletes worldwide and review the up-to-date evidence for its efficacy in reducing sudden cardiac death in young athletes. RECENT FINDINGS A large proportion of sudden cardiac death in young individuals and athletes occurs during rest with sudden arrhythmic death syndrome being recognised as the leading cause. The international recommendations for ECG interpretation have reduced the false-positive ECG rate to 3% and reduced the cost of screening by 25% without compromising the sensitivity to identify serious disease. There are some quality control issues that have been recently identified including the necessity for further training to guide physicians involved in screening young athletes. Improvements in our understanding of young sudden cardiac death and ECG interpretation guideline modification to further differentiate physiological ECG patterns from those that may represent underlying disease have significantly improved the efficacy of screening to levels that may make screening more attractive and feasible to sporting organisations as a complementary strategy to increased availability of automated external defibrillators to reduce the overall burden of young sudden cardiac death.
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Affiliation(s)
- Harshil Dhutia
- Cardiovascular Sciences Research Centre, St George's University of London, London, UK.
- Department of Cardiology, Glenfield Hospital, Leicester, UK.
| | - Hamish MacLachlan
- Cardiovascular Sciences Research Centre, St George's University of London, London, UK
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11
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AMSSM Position Statement on Cardiovascular Preparticipation Screening in Athletes: Current Evidence, Knowledge Gaps, Recommendations, and Future Directions: Erratum. Clin J Sport Med 2018; 28:324. [PMID: 29762263 DOI: 10.1097/jsm.0000000000000382] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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12
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Medical assessment in athletes. Med Clin (Barc) 2018; 150:268-274. [PMID: 29096970 DOI: 10.1016/j.medcli.2017.09.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 08/31/2017] [Accepted: 09/04/2017] [Indexed: 11/21/2022]
Abstract
Practicing sports at a professional level requires the body to be in good health. The fact of carrying out a continuous and high intensity physical activity in the presence of pathological conditions and/or a maladaptation of the body can be detrimental to the athletes' health and, therefore, to their performance. Many of the problems that arise in the sports field could be prevented with a periodic and well-structured medical assessment. In this review, we describe the protocol of the medical service of a high-level sports club for the assessment of its professional athletes.
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13
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Are Lower Extremity Injuries Related to Spinal form Abnormalities in Professional Football Players? A Prospective Cohort Study. Asian J Sports Med 2017. [DOI: 10.5812/asjsm.55543] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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14
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Dhutia H, Malhotra A, Yeo TJ, Ster IC, Gabus V, Steriotis A, Dores H, Mellor G, García-Corrales C, Ensam B, Jayalapan V, Ezzat VA, Finocchiaro G, Gati S, Papadakis M, Tome-Esteban M, Sharma S. Inter-Rater Reliability and Downstream Financial Implications of Electrocardiography Screening in Young Athletes. Circ Cardiovasc Qual Outcomes 2017; 10:e003306. [DOI: 10.1161/circoutcomes.116.003306] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2016] [Accepted: 06/27/2017] [Indexed: 11/16/2022]
Affiliation(s)
- Harshil Dhutia
- From the Cardiology Clinical and Academic Group (H.D., A.M., G.F., S.G., M.P., M.T., S.S.) and Institute of Infection and Immunity (I.C.S.), St. George’s University of London, United Kingdom; Department of Cardiology, National University Heart Centre Singapore, Singapore, China (T.J.Y.); Service of Cardiology, Department of Medicine, Lausanne University Hospital, Lausanne, Switzerland (V.G.); Department of Cardiology, St Bartholomew’s Hospital, London, United Kingdom (A.S., V.A.E.); Armed Forces
| | - Aneil Malhotra
- From the Cardiology Clinical and Academic Group (H.D., A.M., G.F., S.G., M.P., M.T., S.S.) and Institute of Infection and Immunity (I.C.S.), St. George’s University of London, United Kingdom; Department of Cardiology, National University Heart Centre Singapore, Singapore, China (T.J.Y.); Service of Cardiology, Department of Medicine, Lausanne University Hospital, Lausanne, Switzerland (V.G.); Department of Cardiology, St Bartholomew’s Hospital, London, United Kingdom (A.S., V.A.E.); Armed Forces
| | - Tee Joo Yeo
- From the Cardiology Clinical and Academic Group (H.D., A.M., G.F., S.G., M.P., M.T., S.S.) and Institute of Infection and Immunity (I.C.S.), St. George’s University of London, United Kingdom; Department of Cardiology, National University Heart Centre Singapore, Singapore, China (T.J.Y.); Service of Cardiology, Department of Medicine, Lausanne University Hospital, Lausanne, Switzerland (V.G.); Department of Cardiology, St Bartholomew’s Hospital, London, United Kingdom (A.S., V.A.E.); Armed Forces
| | - Irina Chis Ster
- From the Cardiology Clinical and Academic Group (H.D., A.M., G.F., S.G., M.P., M.T., S.S.) and Institute of Infection and Immunity (I.C.S.), St. George’s University of London, United Kingdom; Department of Cardiology, National University Heart Centre Singapore, Singapore, China (T.J.Y.); Service of Cardiology, Department of Medicine, Lausanne University Hospital, Lausanne, Switzerland (V.G.); Department of Cardiology, St Bartholomew’s Hospital, London, United Kingdom (A.S., V.A.E.); Armed Forces
| | - Vincent Gabus
- From the Cardiology Clinical and Academic Group (H.D., A.M., G.F., S.G., M.P., M.T., S.S.) and Institute of Infection and Immunity (I.C.S.), St. George’s University of London, United Kingdom; Department of Cardiology, National University Heart Centre Singapore, Singapore, China (T.J.Y.); Service of Cardiology, Department of Medicine, Lausanne University Hospital, Lausanne, Switzerland (V.G.); Department of Cardiology, St Bartholomew’s Hospital, London, United Kingdom (A.S., V.A.E.); Armed Forces
| | - Alexandros Steriotis
- From the Cardiology Clinical and Academic Group (H.D., A.M., G.F., S.G., M.P., M.T., S.S.) and Institute of Infection and Immunity (I.C.S.), St. George’s University of London, United Kingdom; Department of Cardiology, National University Heart Centre Singapore, Singapore, China (T.J.Y.); Service of Cardiology, Department of Medicine, Lausanne University Hospital, Lausanne, Switzerland (V.G.); Department of Cardiology, St Bartholomew’s Hospital, London, United Kingdom (A.S., V.A.E.); Armed Forces
| | - Helder Dores
- From the Cardiology Clinical and Academic Group (H.D., A.M., G.F., S.G., M.P., M.T., S.S.) and Institute of Infection and Immunity (I.C.S.), St. George’s University of London, United Kingdom; Department of Cardiology, National University Heart Centre Singapore, Singapore, China (T.J.Y.); Service of Cardiology, Department of Medicine, Lausanne University Hospital, Lausanne, Switzerland (V.G.); Department of Cardiology, St Bartholomew’s Hospital, London, United Kingdom (A.S., V.A.E.); Armed Forces
| | - Greg Mellor
- From the Cardiology Clinical and Academic Group (H.D., A.M., G.F., S.G., M.P., M.T., S.S.) and Institute of Infection and Immunity (I.C.S.), St. George’s University of London, United Kingdom; Department of Cardiology, National University Heart Centre Singapore, Singapore, China (T.J.Y.); Service of Cardiology, Department of Medicine, Lausanne University Hospital, Lausanne, Switzerland (V.G.); Department of Cardiology, St Bartholomew’s Hospital, London, United Kingdom (A.S., V.A.E.); Armed Forces
| | - Carmen García-Corrales
- From the Cardiology Clinical and Academic Group (H.D., A.M., G.F., S.G., M.P., M.T., S.S.) and Institute of Infection and Immunity (I.C.S.), St. George’s University of London, United Kingdom; Department of Cardiology, National University Heart Centre Singapore, Singapore, China (T.J.Y.); Service of Cardiology, Department of Medicine, Lausanne University Hospital, Lausanne, Switzerland (V.G.); Department of Cardiology, St Bartholomew’s Hospital, London, United Kingdom (A.S., V.A.E.); Armed Forces
| | - Bode Ensam
- From the Cardiology Clinical and Academic Group (H.D., A.M., G.F., S.G., M.P., M.T., S.S.) and Institute of Infection and Immunity (I.C.S.), St. George’s University of London, United Kingdom; Department of Cardiology, National University Heart Centre Singapore, Singapore, China (T.J.Y.); Service of Cardiology, Department of Medicine, Lausanne University Hospital, Lausanne, Switzerland (V.G.); Department of Cardiology, St Bartholomew’s Hospital, London, United Kingdom (A.S., V.A.E.); Armed Forces
| | - Viknesh Jayalapan
- From the Cardiology Clinical and Academic Group (H.D., A.M., G.F., S.G., M.P., M.T., S.S.) and Institute of Infection and Immunity (I.C.S.), St. George’s University of London, United Kingdom; Department of Cardiology, National University Heart Centre Singapore, Singapore, China (T.J.Y.); Service of Cardiology, Department of Medicine, Lausanne University Hospital, Lausanne, Switzerland (V.G.); Department of Cardiology, St Bartholomew’s Hospital, London, United Kingdom (A.S., V.A.E.); Armed Forces
| | - Vivienne Anne Ezzat
- From the Cardiology Clinical and Academic Group (H.D., A.M., G.F., S.G., M.P., M.T., S.S.) and Institute of Infection and Immunity (I.C.S.), St. George’s University of London, United Kingdom; Department of Cardiology, National University Heart Centre Singapore, Singapore, China (T.J.Y.); Service of Cardiology, Department of Medicine, Lausanne University Hospital, Lausanne, Switzerland (V.G.); Department of Cardiology, St Bartholomew’s Hospital, London, United Kingdom (A.S., V.A.E.); Armed Forces
| | - Gherardo Finocchiaro
- From the Cardiology Clinical and Academic Group (H.D., A.M., G.F., S.G., M.P., M.T., S.S.) and Institute of Infection and Immunity (I.C.S.), St. George’s University of London, United Kingdom; Department of Cardiology, National University Heart Centre Singapore, Singapore, China (T.J.Y.); Service of Cardiology, Department of Medicine, Lausanne University Hospital, Lausanne, Switzerland (V.G.); Department of Cardiology, St Bartholomew’s Hospital, London, United Kingdom (A.S., V.A.E.); Armed Forces
| | - Sabiha Gati
- From the Cardiology Clinical and Academic Group (H.D., A.M., G.F., S.G., M.P., M.T., S.S.) and Institute of Infection and Immunity (I.C.S.), St. George’s University of London, United Kingdom; Department of Cardiology, National University Heart Centre Singapore, Singapore, China (T.J.Y.); Service of Cardiology, Department of Medicine, Lausanne University Hospital, Lausanne, Switzerland (V.G.); Department of Cardiology, St Bartholomew’s Hospital, London, United Kingdom (A.S., V.A.E.); Armed Forces
| | - Michael Papadakis
- From the Cardiology Clinical and Academic Group (H.D., A.M., G.F., S.G., M.P., M.T., S.S.) and Institute of Infection and Immunity (I.C.S.), St. George’s University of London, United Kingdom; Department of Cardiology, National University Heart Centre Singapore, Singapore, China (T.J.Y.); Service of Cardiology, Department of Medicine, Lausanne University Hospital, Lausanne, Switzerland (V.G.); Department of Cardiology, St Bartholomew’s Hospital, London, United Kingdom (A.S., V.A.E.); Armed Forces
| | - Maria Tome-Esteban
- From the Cardiology Clinical and Academic Group (H.D., A.M., G.F., S.G., M.P., M.T., S.S.) and Institute of Infection and Immunity (I.C.S.), St. George’s University of London, United Kingdom; Department of Cardiology, National University Heart Centre Singapore, Singapore, China (T.J.Y.); Service of Cardiology, Department of Medicine, Lausanne University Hospital, Lausanne, Switzerland (V.G.); Department of Cardiology, St Bartholomew’s Hospital, London, United Kingdom (A.S., V.A.E.); Armed Forces
| | - Sanjay Sharma
- From the Cardiology Clinical and Academic Group (H.D., A.M., G.F., S.G., M.P., M.T., S.S.) and Institute of Infection and Immunity (I.C.S.), St. George’s University of London, United Kingdom; Department of Cardiology, National University Heart Centre Singapore, Singapore, China (T.J.Y.); Service of Cardiology, Department of Medicine, Lausanne University Hospital, Lausanne, Switzerland (V.G.); Department of Cardiology, St Bartholomew’s Hospital, London, United Kingdom (A.S., V.A.E.); Armed Forces
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15
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Malhotra A, Dhutia H, Gati S, Yeo TJ, Finnochiaro G, Keteepe-Arachi T, Richards T, Walker M, Birt R, Stuckey D, Robinson L, Tome M, Beasley I, Papadakis M, Sharma S. Emergency response facilities including primary and secondary prevention strategies across 79 professional football clubs in England. Br J Sports Med 2017; 53:813-817. [DOI: 10.1136/bjsports-2016-097440] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2017] [Indexed: 11/04/2022]
Abstract
AimTo assess the emergency response planning and prevention strategies for sudden cardiac arrest (SCA) across a wide range of professional football clubs in England.MethodsA written survey was sent to all professional clubs in the English football league, namely the Premiership, Championship, League 1 and League 2. Outcomes included: (1) number of clubs performing cardiac screening and frequency of screening; (2) emergency planning and documentation; (3) automated external defibrillator (AED) training and availability; and (4) provision of emergency services at sporting venues.Results79 clubs (86%) responded to the survey. 100% clubs participated in cardiac screening. All clubs had AEDs available on match days and during training sessions. 100% Premiership clubs provided AED training to designated staff. In contrast, 30% of lower division clubs with AEDs available did not provide formal training. Most clubs (n=66; 83%) reported the existence of an emergency action plan for SCA but formal documentation was variable. All clubs in the Premiership and League 1 provided an ambulance equipped for medical emergencies on match days compared with 75% of clubs in the Championship and 66% in League 2.ConclusionsThe majority of football clubs in England have satisfactory prevention strategies and emergency response planning in line with European recommendations. Additional improvements such as increasing awareness of European guidelines for emergency planning, AED training and mentorship with financial support to lower division clubs are necessary to further enhance cardiovascular safety of athletes and spectators and close the gap between the highest and lower divisions.
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16
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Drezner JA, O'Connor FG, Harmon KG, Fields KB, Asplund CA, Asif IM, Price DE, Dimeff RJ, Bernhardt DT, Roberts WO. AMSSM Position Statement on Cardiovascular Preparticipation Screening in Athletes: Current Evidence, Knowledge Gaps, Recommendations and Future Directions. Curr Sports Med Rep 2017; 15:359-75. [PMID: 27618246 DOI: 10.1249/jsr.0000000000000296] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Cardiovascular screening in young athletes is widely recommended and routinely performed prior to participation in competitive sports. While there is general agreement that early detection of cardiac conditions at risk for sudden cardiac arrest and death (SCA/D) is an important objective, the optimal strategy for cardiovascular screening in athletes remains an issue of considerable debate. At the center of the controversy is the addition of a resting electrocardiogram (ECG) to the standard preparticipation evaluation using history and physical examination. The American Medical Society for Sports Medicine (AMSSM) formed a task force to address the current evidence and knowledge gaps regarding preparticipation cardiovascular screening in athletes from the perspective of a primary care sports medicine physician. The absence of definitive outcomes-based evidence at this time precludes AMSSM from endorsing any single or universal cardiovascular screening strategy for all athletes, including legislative mandates. This statement presents a new paradigm to assist the individual physician in assessing the most appropriate cardiovascular screening strategy unique to their athlete population, community needs, and resources. The decision to implement a cardiovascular screening program, with or without the addition of ECG, necessitates careful consideration of the risk of SCA/D in the targeted population and the availability of cardiology resources and infrastructure. Importantly, it is the individual physician's assessment in the context of an emerging evidence-base that the chosen model for early detection of cardiac disorders in the specific population provides greater benefit than harm. AMSSM is committed to advancing evidenced-based research and educational initiatives that will validate and promote the most efficacious strategies to foster safe sport participation and reduce SCA/D in athletes.
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Affiliation(s)
- Jonathan A Drezner
- 1Department of Family Medicine, University of Washington, Seattle, WA; 2Department of Military and Emergency Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD; 3Department of Family Medicine, University of North Carolina, Greensboro, NC; 4Department of Health and Kinesiology, Georgia Southern University, Statesboro, GA; 5Department of Family Medicine, University of South Carolina Greenville School of Medicine, Greenville, SC; 6Department of Family Medicine, Carolinas Healthcare System, Charlotte, NC; 7Departments of Orthopedic Surgery, Family & Community Medicine, and Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX; 8Departments of Pediatrics, Orthopedics and Rehabilitation, University of Wisconsin School of Medicine and Public Health, Madison, WI; 9Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, MN
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17
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Mont L, Pelliccia A, Sharma S, Biffi A, Borjesson M, Brugada Terradellas J, Carré F, Guasch E, Heidbuchel H, La Gerche A, Lampert R, McKenna W, Papadakis M, Priori SG, Scanavacca M, Thompson P, Sticherling C, Viskin S, Wilson M, Corrado D, Lip GYH, Gorenek B, Blomström Lundqvist C, Merkely B, Hindricks G, Hernández-Madrid A, Lane D, Boriani G, Narasimhan C, Marquez MF, Haines D, Mackall J, Manuel Marques-Vidal P, Corra U, Halle M, Tiberi M, Niebauer J, Piepoli M. Pre-participation cardiovascular evaluation for athletic participants to prevent sudden death: Position paper from the EHRA and the EACPR, branches of the ESC. Endorsed by APHRS, HRS, and SOLAECE. Eur J Prev Cardiol 2016; 24:41-69. [DOI: 10.1177/2047487316676042] [Citation(s) in RCA: 146] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Lluís Mont
- Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
| | | | | | | | - Mats Borjesson
- Inst of Neuroscience and Physiology and Food, Nutrition and Sport Science and Östra University Hospital, Goteborg, Sweden
| | | | | | - Eduard Guasch
- Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
| | | | - André La Gerche
- Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| | | | | | | | | | - Mauricio Scanavacca
- Instituto do Coração (InCor) do Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | | | | | | | | | | | | | | | | | - Bela Merkely
- Semmelweis University, Heart and Vascular Center, Budapest, Hungary
| | | | - Antonio Hernández-Madrid
- Unidad De Arritmias, Servicio De Cardiologia, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Deirdre Lane
- Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
- Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| | | | | | - Manlio F Marquez
- Departamento de Electrocardiología, Instituto Nacional de Cardiologia Ignacio Chavez, Tlalpan, Mexico
| | - David Haines
- Department of Cardiovascular Medicine, Beaumont Health System, Royal Oak, MI, USA
| | - Judith Mackall
- University Hospitals Case Medical Center, Cleveland, OH, USA
| | | | - Ugo Corra
- IRCCS Rehabilitation Medical Center, Cardiology Department, Salvatore Maugeri Foundation, Veruno, Italy
| | - Martin Halle
- Prevention and Sports Medicine, Technical University Munich, Munich, Germany
| | | | - Josef Niebauer
- Sports Medicine, Prevention & Rehabilitation, Paracelsus Medical University, Salzburg, Austria
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18
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Mont L, Pelliccia A, Sharma S, Biffi A, Borjesson M, Terradellas JB, Carré F, Guasch E, Heidbuchel H, Gerche AL, Lampert R, McKenna W, Papadakis M, Priori SG, Scanavacca M, Thompson P, Sticherling C, Viskin S, Wilson M, Corrado D, Lip GYH, Gorenek B, Lundqvist CB, Merkely B, Hindricks G, Hernández-Madrid A, Lane D, Boriani G, Narasimhan C, Marquez MF, Haines D, Mackall J, Marques-Vidal PM, Corra U, Halle M, Tiberi M, Niebauer J, Piepoli M. Pre-participation cardiovascular evaluation for athletic participants to prevent sudden death: Position paper from the EHRA and the EACPR, branches of the ESC. Endorsed by APHRS, HRS, and SOLAECE. Europace 2016; 19:139-163. [PMID: 27815371 DOI: 10.1093/europace/euw243] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Affiliation(s)
- Lluís Mont
- Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
| | | | | | | | - Mats Borjesson
- Inst of Neuroscience and Physiology and Food, Nutrition and Sport Science and Östra University Hospital, Göteborg, Sweden
| | | | | | - Eduard Guasch
- Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
| | | | - André La Gerche
- Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| | | | | | | | | | - Mauricio Scanavacca
- Instituto do Coração (InCor) do Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | | | | | | | | | | | | | | | | | - Bela Merkely
- Semmelweis University, Heart and Vascular Center, Budapest, Hungary
| | | | - Antonio Hernández-Madrid
- Unidad De Arritmias, Servicio De Cardiologia, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | | | | | | | - Manlio F Marquez
- Departamento de Electrocardiología, Instituto Nacional de Cardiologia Ignacio Chavez, Tlalpan, Mexico
| | - David Haines
- Department of Cardiovascular Medicine, Beaumont Health System, Royal Oak, MI, USA
| | - Judith Mackall
- University Hospitals Case Medical Center, Cleveland, OH, USA
| | | | - Ugo Corra
- IRCCS Rehabilitation Medical Center, Cardiology Department, Salvatore Maugeri Foundation, Veruno, Italy
| | - Martin Halle
- Prevention and Sports Medicine, Technical University Munich, Munich, Germany
| | | | - Josef Niebauer
- Sports Medicine, Prevention & Rehabilitation, Paracelsus Medical University, Salzburg, Austria
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19
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Drezner JA, O'Connor FG, Harmon KG, Fields KB, Asplund CA, Asif IM, Price DE, Dimeff RJ, Bernhardt DT, Roberts WO. AMSSM Position Statement on Cardiovascular Preparticipation Screening in Athletes: Current evidence, knowledge gaps, recommendations and future directions. Br J Sports Med 2016; 51:153-167. [PMID: 27660369 DOI: 10.1136/bjsports-2016-096781] [Citation(s) in RCA: 90] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2016] [Indexed: 11/04/2022]
Abstract
Cardiovascular screening in young athletes is widely recommended and routinely performed prior to participation in competitive sports. While there is general agreement that early detection of cardiac conditions at risk for sudden cardiac arrest and death (SCA/D) is an important objective, the optimal strategy for cardiovascular screening in athletes remains an issue of considerable debate. At the centre of the controversy is the addition of a resting ECG to the standard preparticipation evaluation using history and physical examination. The American Medical Society for Sports Medicine (AMSSM) formed a task force to address the current evidence and knowledge gaps regarding preparticipation cardiovascular screening in athletes from the perspective of a primary care sports medicine physician. The absence of definitive outcome-based evidence at this time precludes AMSSM from endorsing any single or universal cardiovascular screening strategy for all athletes, including legislative mandates. This statement presents a new paradigm to assist the individual physician in assessing the most appropriate cardiovascular screening strategy unique to their athlete population, community needs and resources. The decision to implement a cardiovascular screening programme, with or without the addition of ECG, necessitates careful consideration of the risk of SCA/D in the targeted population and the availability of cardiology resources and infrastructure. Importantly, it is the individual physician's assessment in the context of an emerging evidence base that the chosen model for early detection of cardiac disorders in the specific population provides greater benefit than harm. AMSSM is committed to advancing evidenced-based research and educational initiatives that will validate and promote the most efficacious strategies to foster safe sport participation and reduce SCA/D in athletes.
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Affiliation(s)
- Jonathan A Drezner
- Department of Family Medicine, University of Washington, Seattle, Washington, USA
| | - Francis G O'Connor
- Department of Military and Emergency Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Kimberly G Harmon
- Department of Family Medicine, University of Washington, Seattle, Washington, USA
| | - Karl B Fields
- Department of Family Medicine, University of North Carolina, Greensboro, North Carolina, USA
| | - Chad A Asplund
- Department of Health and Kinesiology, Georgia Southern University, Statesboro, Georgia, USA
| | - Irfan M Asif
- Department of Family Medicine, University of South Carolina Greenville School of Medicine, Greenville, South Carolina, USA
| | - David E Price
- Department of Family Medicine, Carolinas Healthcare System, Charlotte, North Carolina, USA
| | - Robert J Dimeff
- Departments of Orthopedic Surgery, Family and Community Medicine, and Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - David T Bernhardt
- Departments of Pediatrics, Orthopedics and Rehabilitation, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - William O Roberts
- Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, Minnesota, USA
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20
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Hainline B, Drezner J, Baggish A, Harmon KG, Emery MS, Myerburg RJ, Sanchez E, Molossi S, Parsons JT, Thompson PD. Interassociation consensus statement on cardiovascular care of college student-athletes. Br J Sports Med 2016; 51:74-85. [PMID: 27247099 DOI: 10.1136/bjsports-2016-096323] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2016] [Indexed: 12/24/2022]
Abstract
Cardiovascular evaluation and care of college student-athletes is gaining increasing attention from both the public and medical communities. Emerging strategies include screening of the general athlete population, recommendations of permissible levels of participation by athletes with identified cardiovascular conditions and preparation for responding to unanticipated cardiac events in athletic venues. The primary focus has been sudden cardiac death and the usefulness of screening with or without advanced cardiac screening. The National Collegiate Athletic Association convened a multidisciplinary task force to address cardiovascular concerns in collegiate student-athletes, and to develop consensus for an interassociation statement. This document summarises the task force deliberations and follow-up discussions, and includes available evidence on cardiovascular risk, preparticipation evaluation and the recognition of and response to cardiac arrest. Future recommendations for cardiac research initiatives, education and collaboration are also provided.
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Affiliation(s)
- Brian Hainline
- Sport Science Institute, National Collegiate Athletic Association, Indianapolis, Indiana, USA
| | - Jonathan Drezner
- Department of Family Medicine, University of Washington, Seattle, Washington, USA
| | - Aaron Baggish
- Cardiovascular Performance Program, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Kimberly G Harmon
- Department of Family Medicine, University of Washington, Seattle, Washington, USA
| | - Michael S Emery
- Krannert Institute of Cardiology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Robert J Myerburg
- Division of Cardiology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | | | - Silvana Molossi
- Division of Pediatric Cardiology, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - John T Parsons
- Sport Science Institute, National Collegiate Athletic Association, Indianapolis, Indiana, USA
| | - Paul D Thompson
- Division of Cardiology, Hartford Hospital, Hartford, Connecticut, USA
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21
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Hainline B, Drezner JA, Baggish A, Harmon KG, Emery MS, Myerburg RJ, Sanchez E, Molossi S, Parsons JT, Thompson PD. Interassociation Consensus Statement on Cardiovascular Care of College Student-Athletes. J Am Coll Cardiol 2016; 67:2981-95. [PMID: 27090220 DOI: 10.1016/j.jacc.2016.03.527] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Revised: 03/18/2016] [Accepted: 03/21/2016] [Indexed: 10/21/2022]
Abstract
Cardiovascular evaluation and care of college student-athletes is gaining increasing attention from both the public and medical communities. Emerging strategies include screening of the general athlete population, recommendations of permissible levels of participation by athletes with identified cardiovascular conditions, and preparation for responding to unanticipated cardiac events in athletic venues. The primary focus has been sudden cardiac death and the utility of screening with or without advanced cardiac screening. The National Collegiate Athletic Association convened a multidisciplinary task force to address cardiovascular concerns in collegiate student-athletes and to develop consensus for an interassociation statement. This document summarizes the task force deliberations and follow-up discussions, and includes available evidence on cardiovascular risk, pre-participation evaluation, and the recognition of and response to cardiac arrest. Future recommendations for cardiac research initiatives, education, and collaboration are also provided.
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Affiliation(s)
- Brian Hainline
- Sport Science Institute, National Collegiate Athletic Association, Indianapolis, Indiana.
| | - Jonathan A Drezner
- Department of Family Medicine, University of Washington, Seattle, Washington
| | - Aaron Baggish
- Cardiovascular Performance Program, Massachusetts General Hospital, Boston, Massachusetts
| | - Kimberly G Harmon
- Department of Family Medicine, University of Washington, Seattle, Washington
| | - Michael S Emery
- Krannert Institute of Cardiology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Robert J Myerburg
- Division of Cardiology, University of Miami Miller School of Medicine, Miami, Florida
| | | | - Silvana Molossi
- Division of Pediatric Cardiology, Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - John T Parsons
- Sport Science Institute, National Collegiate Athletic Association, Indianapolis, Indiana
| | - Paul D Thompson
- Division of Cardiology, Hartford Hospital, Hartford, Connecticut
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22
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Hainline B, Drezner J, Baggish A, Harmon KG, Emery MS, Myerburg RJ, Sanchez E, Molossi S, Parsons JT, Thompson PD. Interassociation Consensus Statement on Cardiovascular Care of College Student-Athletes. J Athl Train 2016; 51:344-57. [PMID: 27111694 PMCID: PMC4874378 DOI: 10.4085/j.jacc.2016.03.527] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Revised: 03/18/2016] [Accepted: 03/21/2016] [Indexed: 11/09/2022]
Abstract
Cardiovascular evaluation and care of college student-athletes is gaining increasing attention from both the public and medical communities. Emerging strategies include screening of the general athlete population, recommendations of permissible levels of participation by athletes with identified cardiovascular conditions, and preparation for responding to unanticipated cardiac events in athletic venues. The primary focus has been sudden cardiac death and the utility of screening with or without advanced cardiac screening. The National Collegiate Athletic Association convened a multidisciplinary task force to address cardiovascular concerns in collegiate student-athletes and to develop consensus for an interassociation statement. This document summarizes the task force deliberations and follow-up discussions, and includes available evidence on cardiovascular risk, pre-participation evaluation, and the recognition of and response to cardiac arrest. Future recommendations for cardiac research initiatives, education, and collaboration are also provided. (J Am Coll Cardiol 2016;doi: 10.1016/j.jacc.2016.03.527.)
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Affiliation(s)
- Brian Hainline
- From the a Sport Science Institute, National Collegiate Athletic Association, Indianapolis, Indiana
| | - Jonathan Drezner
- b Department of Family Medicine, University of Washington, Seattle, Washington
| | - Aaron Baggish
- c Cardiovascular Performance Program, Massachusetts General Hospital, Boston, Massachusetts
| | - Kimberly G Harmon
- b Department of Family Medicine, University of Washington, Seattle, Washington
| | - Michael S Emery
- d Krannert Institute of Cardiology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Robert J Myerburg
- e Division of Cardiology, University of Miami Miller School of Medicine, Miami, Florida
| | | | - Silvana Molossi
- g Division of Pediatric Cardiology, Department of Pediatrics, Baylor College of Medicine, Houston, Texas; and the
| | - John T Parsons
- From the a Sport Science Institute, National Collegiate Athletic Association, Indianapolis, Indiana
| | - Paul D Thompson
- h Division of Cardiology, Hartford Hospital, Hartford, Connecticut
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Bakken A, Targett S, Bere T, Adamuz MC, Tol JL, Whiteley R, Wilson MG, Witvrouw E, Khan KM, Bahr R. Health conditions detected in a comprehensive periodic health evaluation of 558 professional football players. Br J Sports Med 2016; 50:1142-50. [PMID: 27012663 DOI: 10.1136/bjsports-2015-095829] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2016] [Indexed: 01/02/2023]
Abstract
BACKGROUND Despite the widespread use of periodic health evaluation (PHE) to detect and prevent injury and illness in athletes, its effectiveness in detecting health conditions and relevant risk factors is still debated. AIM To assess health conditions detected by a comprehensive PHE in professional male football players and evaluate their consequences for participation clearance. METHODS A total of 558 professional football players in Qatar completed a PHE prior to the 2013 or 2014 seasons: history, general medical (including blood test), cardiovascular (12-lead ECG and echocardiography) and a musculoskeletal examination, including a specific test battery targeting lower extremity strength and flexibility. On the basis of the PHE, players were either cleared or not cleared for participation. RESULTS In 533 players (95.5%), at least one health condition was detected requiring treatment or follow-up. Vitamin D deficiency or insufficiency (≤30 ng/mL) was the most common medical condition (n=499, 89.4%), followed by hepatitis B non-immunity or infection (n=164, 29.4%). Cardiac screening identified 48 players (8.6%) with one or more abnormal findings (ECG (n=19, 3.4%) and echocardiography (n=14, 2.5%)). Musculoskeletal conditions were observed in 180 players (32.3%); injuries to or strength deficits of the hip/groin and thigh accounted for the largest proportion. Medical clearance was temporarily not given in 69 players (12.4%), while further examinations were being conducted. One player was disqualified from competitive football. CONCLUSIONS PHE revealed a high prevalence of health conditions requiring treatment or follow-up in professional footballers; however, only 12.4% of conditions impacted on final clearance for participation.
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Affiliation(s)
- Arnhild Bakken
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar Department of Sports Medicine, Oslo Sports Trauma Research Center, Norwegian School of Sport Sciences, Oslo, Norway
| | - Stephen Targett
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Tone Bere
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar Department of Orthopaedics, Oslo University Hospital, Oslo, Norway
| | | | - Johannes L Tol
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar The Sports Physician Group, Department of Sports Medicine, St Lucas Andreas Hospital, Amsterdam, The Netherlands Amsterdam Center of Evidence Based Sports Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - Rod Whiteley
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Mathew G Wilson
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar Research Institute of Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK Research Institute of Sport and Exercise Sciences, University of Canberra, Australia
| | - Erik Witvrouw
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Karim M Khan
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Roald Bahr
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar Department of Sports Medicine, Oslo Sports Trauma Research Center, Norwegian School of Sport Sciences, Oslo, Norway
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Abstract
Background FIFA has surveyed match injuries in its tournaments since 1998. Aim To analyse the incidence and characteristics of match injuries incurred during the 2014 FIFA World Cup in comparison to previous FIFA World Cups. Methods The chief physicians of the participating teams reported all newly incurred injuries of their players after the match on a standardised report form. 124 (97%) forms were returned. Results A total of 104 injuries were reported, equivalent to an incidence of 1.68 injuries per match (95% CI 1.36 to 2.00). 64 (63.4%) injuries were caused by contact with another player. Thigh (26; 25%) and head (19; 18%) were the most frequently injured body parts. The most frequent diagnosis was thigh strain (n=18). Five concussions and three fractures to the head were reported. While most thigh strains (15/17; 88.2%) occurred without contact, almost all head injuries (18/19; 94.7%) were caused by contact. 0.97 injuries per match (95% CI 0.72 to 1.22) were expected to result in absence from training or match. Eight injuries were classified as severe. The incidence of match injuries in the 2014 FIFA World Cup was significantly lower than the average of the four preceding FIFA World Cups, both for all injuries (2.34; 95% CI 2.15 to 2.53) and time-loss injuries (1.51; 95% CI 1.37 to 1.65). Conclusions The overall incidence of injury during the FIFA World Cups decreased from 2002 to 2014 by 37%. A detailed analysis of the injury mechanism is recommended to further improve prevention strategies.
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Affiliation(s)
- Astrid Junge
- FIFA Medical Assessment and Research Centre (F-MARC), Zürich, Switzerland Schulthess Klinik, Zürich, Switzerland Medical School Hamburg (MSH), Hamburg, Germany
| | - Jiri Dvořák
- FIFA Medical Assessment and Research Centre (F-MARC), Zürich, Switzerland Schulthess Klinik, Zürich, Switzerland Fédération Internationale de Football Association (FIFA), Zürich, Switzerland
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Kramer EB, Dvorak J, Schmied C, Meyer T. F-MARC: promoting the prevention and management of sudden cardiac arrest in football. Br J Sports Med 2016; 49:597-8. [PMID: 25878076 PMCID: PMC4413678 DOI: 10.1136/bjsports-2015-094764] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Sudden cardiac death is the most common cause of unnatural death in football. To prevent and urgently manage sudden cardiac arrest on the football field-of-play, F-MARC (FIFA Medical and Research Centre) has been fully committed to a programme of research, education, standardisation and practical implementation. This strategy has detected football players at medical risk during mandatory precompetition medical assessments. Additionally, FIFA has (1) sponsored internationally accepted guidelines for the interpretation of an athlete's ECG, (2) developed field-of-play-specific protocols for the recognition, response, resuscitation and removal of a football player having sudden cardiac arrest and (3) introduced and distributed the FIFA medical emergency bag which has already resulted in the successful resuscitation of a football player who had a sudden cardiac arrest on the field-of-play. Recently FIFA, in association with the Institute of Sports and Preventive Medicine in Saarbrücken, Germany, established a worldwide Sudden Death Registry with a view to documenting fatal events on the football field-of-play. These activities by F-MARC are testimony to FIFA's continued commitment to minimising sudden cardiac arrest while playing football.
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Affiliation(s)
- Efraim Benjamin Kramer
- Division of Emergency Medicine, Witwatersrand University, Johannesburg, Gauteng, South Africa
| | - J Dvorak
- F-MARC, Schulthess Clinic Zürich, Zürich, Switzerland
| | - C Schmied
- Clinic of Cardiology, University Heart Center, Zürich, Switzerland
| | - T Meyer
- Institute of Sports and Preventive Medicine, Saarland University, Saarbrücken, Germany
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The Psychological Impact of Cardiovascular Screening in Young Athletes: Perspectives Across Age, Race, and Gender. Clin J Sport Med 2015; 25:464-71. [PMID: 25654630 DOI: 10.1097/jsm.0000000000000180] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine the psychological impact of electrocardiogram (ECG) screening in young competitive athletes based on age, race, and gender. DESIGN Prospective multisite cross-sectional investigation. SETTING Young competitive athletes. PATIENTS One thousand five hundred six high school athletes (59.3% male with a mean age of 15.5 years, 56.2% white, 24.5% African American). INDEPENDENT VARIABLES Athletes underwent screening with a standardized American Heart Association-based history, physical examination, and ECG. MAIN OUTCOME MEASURES Prescreen and postscreen validated assessments for health attitudes, anxiety, and impact of screening on sport. RESULTS Of the athletes participated, 76.3% had normal screens, 22.7% false-positive (FP) results (12.9% history, 4.2% examination, 3.1% ECG), and 0.9% were diagnosed with serious cardiac disorders. There were no differences in anxiety levels among athletes screening normal versus FP (P = 0.69). There was no difference in anxiety based on the reason for a FP result (history, physical examination, or ECG) both during (P = 0.95) and after (P = 0.40) screening. Analysis by age, race, and gender demonstrated that before screening, females were more likely to prefer knowing about underlying cardiac conditions compared with males (P < 0.001), and males were less concerned about having cardiac disease (P < 0.001) compared with females. African Americans were less concerned about underlying disease (P < 0.001) and less interested (P < 0.001) in cardiac screening compared with whites. Athletes diagnosed with a cardiac disease described anxiety after screening, but still believe that all athletes should receive an ECG before competition. CONCLUSIONS Electrocardiogram screening does not cause excessive anxiety in US high school athletes across spectrums of age, race, and gender. Recognition of age, race, and gender-specific perspectives could improve physician-patient dialogue and support mechanisms for those diagnosed with potentially lethal cardiac disorders. CLINICAL RELEVANCE This article provides evidence that undue anxiety should not be used as an argument against the implementation of ECG screening during the preparticipation examinaton for young athletes. Although males and African Americans seem to be at highest risk for sudden cardiac death during exercise, they actually report being the least concerned and least worried about potentially harboring an underlying condition that might predispose them to such an event. Emotional support should readily be available for athletes who are diagnosed with cardiovascular conditions as these individuals report emotional distress after their diagnosis.
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Schnell F, Claessen G, La Gerche A, Bogaert J, Lentz PA, Claus P, Mabo P, Carré F, Heidbuchel H. Subepicardial delayed gadolinium enhancement in asymptomatic athletes: let sleeping dogs lie? Br J Sports Med 2015. [DOI: 10.1136/bjsports-2014-094546] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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28
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Edouard P, Jacobsson J, Timpka T, Alonso JM, Kowalski J, Nilsson S, Karlsson D, Depiesse F, Branco P. Extending in-competition Athletics injury and illness surveillance with pre-participation risk factor screening: A pilot study. Phys Ther Sport 2015; 16:98-106. [DOI: 10.1016/j.ptsp.2014.05.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Revised: 04/10/2014] [Accepted: 05/26/2014] [Indexed: 10/25/2022]
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Stages of psychological impact after diagnosis with serious or potentially lethal cardiac disease in young competitive athletes: A new model. J Electrocardiol 2015; 48:298-310. [DOI: 10.1016/j.jelectrocard.2014.12.018] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Indexed: 11/21/2022]
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Leischik R, Dworrak B, Foshag P, Strauss M, Spelsberg N, Littwitz H, Horlitz M. Pre-participation and follow-up screening of athletes for endurance sport. J Clin Med Res 2015; 7:385-92. [PMID: 25883700 PMCID: PMC4394910 DOI: 10.14740/jocmr2129w] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2015] [Indexed: 12/17/2022] Open
Abstract
Physical activity increases life expectancy and sport is a priori not harmful. Exhausted sporting activity (e.g. endurance running, triathlon, cycling or competitive sport) can lead under individual conditions to negative cardiac remodelling (pathological enlargement/function of cardiac cavities/structures) or in worst case to cardiac arrhythmias and sudden cardiac death (SCD). This individually disposition can be genetically determined or behaviourally/environmentally acquired. Overall competitive young male athletes suffer five-fold higher than non-competitive athletes from sudden death and athletes aged over 30 bear a potential for arrhythmias, atrial fibrillation or a 20-fold higher possibility for SCD as female athletes. Patients with diabetes, coronary disease, obesity or hypertension require different special managements. Screening of cardiorespiratory health for sport activities has a lot of faces. Basically there is a need for indicated examinations or possible preventive measures inside or outside of pre-competition screening. The costs of screening compared to expenditure of whole effort for sporting activities are acceptable or even negligible, but of course dependent on national/regional settings. The various causes and possibilities of screening will be discussed in this article as basic suggestion for an open discussion beyond national borders and settings.
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Affiliation(s)
- Roman Leischik
- Faculty of Health, School of Medicine, University Witten/Herdecke, Germany
| | - Birgit Dworrak
- Faculty of Health, School of Medicine, University Witten/Herdecke, Germany
| | - Peter Foshag
- Faculty of Health, School of Medicine, University Witten/Herdecke, Germany
| | - Markus Strauss
- Faculty of Health, School of Medicine, University Witten/Herdecke, Germany
| | - Norman Spelsberg
- Faculty of Health, School of Medicine, University Witten/Herdecke, Germany
| | - Henning Littwitz
- Faculty of Health, School of Medicine, University Witten/Herdecke, Germany
| | - Marc Horlitz
- Faculty of Health, School of Medicine, University Witten/Herdecke, Germany
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31
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Asif IM, Harmon KG. The Role of Screening for Sudden Cardiac Death in Young Competitive Athletes: A Critical Review. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2015. [DOI: 10.1007/s40141-014-0072-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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32
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Tischer SG, Mattsson N, Storgaard M, Høfsten DE, Høst NB, Andersen LJ, Prescott E, Rasmusen HK. Results of voluntary cardiovascular examination of elite athletes in Denmark: Proposal for Nordic collaboration. Scand J Med Sci Sports 2015; 26:64-73. [DOI: 10.1111/sms.12405] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/11/2014] [Indexed: 01/17/2023]
Affiliation(s)
- S. G. Tischer
- Department of Cardiology; Bispebjerg Hospital; University of Copenhagen; Copenhagen Denmark
| | - N. Mattsson
- Department of Cardiology; Bispebjerg Hospital; University of Copenhagen; Copenhagen Denmark
| | - M. Storgaard
- Sports Medical Team; Team Denmark; Brøndby Denmark
| | - D. E. Høfsten
- Department of Cardiology; Rigshospitalet; University of Copenhagen; Copenhagen Denmark
| | - N. B. Høst
- Department of Cardiology; Bispebjerg Hospital; University of Copenhagen; Copenhagen Denmark
| | - L. J. Andersen
- Department of Cardiology; Roskilde Hospital; Roskilde Denmark
| | - E. Prescott
- Department of Cardiology; Bispebjerg Hospital; University of Copenhagen; Copenhagen Denmark
| | - H. K. Rasmusen
- Department of Cardiology; Bispebjerg Hospital; University of Copenhagen; Copenhagen Denmark
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Modern standards of ECG interpretation in young athletes: yield and effectiveness. J Electrocardiol 2015; 48:292-7. [PMID: 25595717 DOI: 10.1016/j.jelectrocard.2014.12.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Indexed: 10/24/2022]
Abstract
Although cardiovascular screening is recommended before participating in competitive sports, the role of the 12-lead electrocardiogram (ECG) has been debated. When added to the medical history and physical examination, an ECG used during the pre-participation screening (PPS) of young athletes can greatly enhance the ability to detect underlying cardiovascular pathology. Concerns over false positive rates, however, have posed an obstacle to large-scale implementation. The recent development of modern athlete-specific ECG interpretation criteria has dramatically reduced false positive rates to levels below other commonly used screening tests (e.g. breast cancer, prostate cancer) and subsequently improved cost effectiveness. There are also emerging data that certain sub-groups have a higher prevalence of ECG abnormalities, including males, athletes of Afro-Caribbean descent, basketball players, and endurance athletes. While false positive rates from a number of studies are reduced with the improved standards, there may be room for continued improvements. Future efforts should focus on refining criteria based on age, race, gender, ethnicity, and sport, while also clearly delineating the appropriate work-up strategies for those with abnormal findings, as this can lead to improved resource utilization.
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Maron BJ, Friedman RA, Kligfield P, Levine BD, Viskin S, Chaitman BR, Okin PM, Saul JP, Salberg L, Van Hare GF, Soliman EZ, Chen J, Matherne GP, Bolling SF, Mitten MJ, Caplan A, Balady GJ, Thompson PD. Assessment of the 12-Lead ECG as a Screening Test for Detection of Cardiovascular Disease in Healthy General Populations of Young People (12–25 Years of Age). Circulation 2014; 130:1303-34. [DOI: 10.1161/cir.0000000000000025] [Citation(s) in RCA: 158] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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35
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Maron BJ, Friedman RA, Kligfield P, Levine BD, Viskin S, Chaitman BR, Okin PM, Saul JP, Salberg L, Van Hare GF, Soliman EZ, Chen J, Matherne GP, Bolling SF, Mitten MJ, Caplan A, Balady GJ, Thompson PD. Assessment of the 12-lead electrocardiogram as a screening test for detection of cardiovascular disease in healthy general populations of young people (12-25 years of age): a scientific statement from the American Heart Association and the American College of Cardiology. J Am Coll Cardiol 2014; 64:1479-514. [PMID: 25234655 DOI: 10.1016/j.jacc.2014.05.006] [Citation(s) in RCA: 140] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Quattrini FM, Pelliccia A, Assorgi R, DiPaolo FM, Squeo MR, Culasso F, Castelli V, Link MS, Maron BJ. Benign clinical significance of J-wave pattern (early repolarization) in highly trained athletes. Heart Rhythm 2014; 11:1974-82. [PMID: 25092400 DOI: 10.1016/j.hrthm.2014.07.042] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Indexed: 02/08/2023]
Abstract
BACKGROUND J wave/QRS slurring (early repolarization) on 12-lead ECG has been associated with increased risk for ventricular fibrillation in the absence of cardiovascular (CV) disease. OBJECTIVE The purpose of this study was to assess the prevalence and clinical significance of J wave/QRS slurring in a large population of competitive athletes. METHODS Seven hundred four athletes (436 males [62%], age 25 ± 5 years) free of CV disease who had engaged in 30 different sports were examined. Serial clinical, ECG, and echocardiographic evaluations were available over 1 to 18 years of follow-up (mean 6 ± 4 years). RESULTS J wave was found in 102 athletes (14%) and was associated with QRS slurring in 32 (4%). It was found most commonly in anterior, lateral, and inferior leads (n = 73 [72%]), occasionally in lateral leads (n = 26 [25%]), and rarely in inferior leads (n = 3 [3%]). Most of 102 athletes (n = 86 [84%]) also showed ST-segment elevation. J wave/QRS slurring was associated with other training-related ECG changes (ie, increased R/S-wave voltages in 76%) and left ventricular (LV) morphologic remodeling (LV mass 199 ± 48 g vs 188 ± 56 g, P <.05). During follow-up, no athlete with J wave experienced cardiac event or ventricular tachyarrhythmias, or developed structural CV disease. CONCLUSION In athletes, early repolarization pattern usually is associated with other ECG changes, such as increased QRS voltages and ST-segment elevation, as well as LV remodeling, suggesting that it likely represents another benign expression of the physiologic athlete's heart. J wave (early repolarization) is common in highly trained athletes and does not convey risk for adverse cardiac events, including sudden death or tachyarrhythmias.
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Affiliation(s)
- Filippo M Quattrini
- Institute of Sport Medicine and Science, Italian National Olympic Committee, Rome, Italy
| | - Antonio Pelliccia
- Institute of Sport Medicine and Science, Italian National Olympic Committee, Rome, Italy.
| | - Riccardo Assorgi
- Institute of Sport Medicine and Science, Italian National Olympic Committee, Rome, Italy
| | - Fernando M DiPaolo
- Institute of Sport Medicine and Science, Italian National Olympic Committee, Rome, Italy
| | - Maria Rosaria Squeo
- Institute of Sport Medicine and Science, Italian National Olympic Committee, Rome, Italy
| | - Franco Culasso
- Department of Experimental Medicine, University La Sapienza, Rome, Italy
| | | | | | - Barry J Maron
- Hypertrophic Cardiomyopathy Center, Minneapolis Heart Institute Foundation, Minneapolis. Minnesota
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Asif IM, Johnson S, Schmieg J, Smith T, Rao AL, Harmon KG, Salerno JC, Drezner JA. The psychological impact of cardiovascular screening: the athlete's perspective. Br J Sports Med 2014; 48:1162-6. [DOI: 10.1136/bjsports-2014-093500] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Dvorak J, Saugy M, Pitsiladis YP. Challenges and threats to implementing the fight against doping in sport. Br J Sports Med 2014; 48:807-9. [DOI: 10.1136/bjsports-2014-093589] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Panhuyzen-Goedkoop NM, Smeets JLRM. Legal responsibilities of physicians when making participation decisions in athletes with cardiac disorders: Do guidelines provide a solid legal footing? Br J Sports Med 2014; 48:1193-5. [DOI: 10.1136/bjsports-2013-093023] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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40
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Exeter DJ, Elley CR, Fulcher ML, Lee AC, Drezner JA, Asif IM. Standardised criteria improve accuracy of ECG interpretation in competitive athletes: a randomised controlled trial. Br J Sports Med 2014; 48:1167-71. [DOI: 10.1136/bjsports-2013-093360] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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41
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Price DE, McWilliams A, Asif IM, Martin A, Elliott SD, Dulin M, Drezner JA. Electrocardiography-inclusive screening strategies for detection of cardiovascular abnormalities in high school athletes. Heart Rhythm 2014; 11:442-9. [DOI: 10.1016/j.hrthm.2013.12.002] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2013] [Indexed: 11/29/2022]
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Heron N, Cupples M. The health profile of football/soccer players in Northern Ireland - a review of the uefa pre-participation medical screening procedure. BMC Sports Sci Med Rehabil 2014; 6:5. [PMID: 24521343 PMCID: PMC4021641 DOI: 10.1186/2052-1847-6-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2013] [Accepted: 02/10/2014] [Indexed: 01/16/2023]
Abstract
Background It is compulsory that domestic football/soccer teams in UEFA competitions organise players’ pre-participation medicals. Although screening guidelines have been established, these remain controversial. The findings of medical examinations can have lasting consequences for athletes and doctors. No previous studies have reported UEFA pre-participation screening results in semi-professional footballers. This study aims to further knowledge regarding ‘normal’ data in this population. Method Retrospective audit and analysis of records of pre-season medicals for all male first-team players at one semi-professional Northern Ireland Premiership team between 2009-2012. Medicals were conducted by the club doctor following the UEFA proforma. Height, weight, blood pressure (BP), full blood count (FBC), dipstick urinalysis and resting electrocardiogram (ECG) were conducted by an independent nurse. Only one ECG must be documented during a player’s career; other tests are repeated yearly. Results 89 medicals from 47 players (6 goalkeepers, 11 defenders, 22 midfielders and 8 attackers; mean age 25.0 years (SD 4.86)) were reviewed. Mean height of the players was 179.3 cm (SD 5.90) with a mean weight of 77.6 kg (SD 10.5). Of 89 urine dipsticks, 7 were positive for protein; all 7 were normal on repeat testing following 48 hours of rest. Of 40 ECGs (mean ventricular rate 61.2 bpm (SD 11.6)), one was referred to cardiology (right bundle branch block; prolonged Q-T interval). No players were excluded from participation. Conclusions This study provides important information about ‘normal’ values in a population of semi-professional footballers. Urinalysis showing protein is not uncommon but is likely to be normal on repeat testing.
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Affiliation(s)
- Neil Heron
- Department of General Practice and Primary Care, Queen's University, Belfast, Irelan.
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Menafoglio A, Di Valentino M, Segatto JM, Siragusa P, Pezzoli R, Maggi M, Romano GA, Moschovitis G, Wilhelm M, Gallino A. Costs and yield of a 15-month preparticipation cardiovascular examination with ECG in 1070 young athletes in Switzerland: implications for routine ECG screening. Br J Sports Med 2014; 48:1157-61. [DOI: 10.1136/bjsports-2013-092929] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Shurlock B. Expenses for meetings and fees for service: details of 'disclosure' required of pharmaceutical companies. Eur Heart J 2013; 34:3589-90. [PMID: 24335158 DOI: 10.1093/eurheartj/eht460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Mountjoy M, Junge A. The role of International Sport Federations in the protection of the athlete's health and promotion of sport for health of the general population. Br J Sports Med 2013; 47:1023-7. [DOI: 10.1136/bjsports-2013-092999] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Dvorak J, Kramer EB, Schmied CM, Drezner JA, Zideman D, Patricios J, Correia L, Pedrinelli A, Mandelbaum B. The FIFA medical emergency bag and FIFA 11 steps to prevent sudden cardiac death: setting a global standard and promoting consistent football field emergency care. Br J Sports Med 2013; 47:1199-202. [PMID: 23940271 DOI: 10.1136/bjsports-2013-092767] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Life-threatening medical emergencies are an infrequent but regular occurrence on the football field. Proper prevention strategies, emergency medical planning and timely access to emergency equipment are required to prevent catastrophic outcomes. In a continuing commitment to player safety during football, this paper presents the FIFA Medical Emergency Bag and FIFA 11 Steps to prevent sudden cardiac death. These recommendations are intended to create a global standard for emergency preparedness and the medical response to serious or catastrophic on-field injuries in football.
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Gawroński W, Sobiecka J, Malesza J. Fit and healthy Paralympians—medical care guidelines for disabled athletes: a study of the injuries and illnesses incurred by the Polish Paralympic team in Beijing 2008 and London 2012. Br J Sports Med 2013; 47:844-9. [DOI: 10.1136/bjsports-2013-092298] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Affiliation(s)
- Philipp Bohm
- a Institute of Sports and Preventive Medicine , Saarland University , Saarbrücken , Germany
| | | | - Tim Meyer
- a Institute of Sports and Preventive Medicine , Saarland University , Saarbrücken , Germany
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Schmied C, Drezner J, Kramer E, Dvorak J. Cardiac events in football and strategies for first-responder treatment on the field. Br J Sports Med 2013; 47:1175-8. [DOI: 10.1136/bjsports-2012-091918] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Schmied C, Di Paolo FM, Zerguini AY, Dvorak J, Pelliccia A. Screening athletes for cardiovascular disease in Africa: a challenging experience. Br J Sports Med 2013; 47:579-84. [DOI: 10.1136/bjsports-2012-091803] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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