No problems were detected when Fabrice Muamba had a heart scan at the start of the season as part of Bolton Wanderers’ screening programme, which includes performing an annual electrocardiograph (ECG) on players.
Although monitoring players in England has never been more comprehensive, some have advocated a more rigorous testing programme and, ideally, players with the highest risk factors, such as a family history or potential genetic problems, would be continually checked. As it is, though, all players are screened when they sign professional contracts at 16 and most likely when they are transferred, but not all clubs do regular checks.
Although playing football can help to prevent cardiovascular disease, taking part in competitive sports can act as a trigger for sudden cardiac death.
There were 957 tests at a cost of £300 each on youngsters last year, funded by the FA and the Professional Footballers’ Association (PFA), who run a scheme that is in its fifteenth year. Players complete a questionnaire and undergo an ECG and echocardiograph.
“Our programme has picked up one or two instances each year, which can be a real disappointment to the player and the parents, but we feel duty-bound to say, ‘You need to know this and then it is your decision,’” Gordon Taylor, the chief executive of the PFA, said.
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One problem with screening youngsters only at 16 is that the heart does not stop growing, which is why the Italians are regarded as having the “gold standard” for testing players every two years between 16 and 21. Their clubs bear the cost.
Another issue is that some players are willing to lie about their family medical history for fear that it might affect their chance of a contract. There are also issues about the club doctor reading the scans, without the speciality of a cardiologist, who in turn, may not know a player’s individual history.
Conditions that develop after 16 may not be detected, while the large number of players entering the game from abroad will not have passed through the scheme and their medical records are sometimes not available. The Premier League requires that annual medical examinations should be carried out on all players. Tottenham Hotspur, for example, will carry out subsequent screenings, either annually or biannually, depending on the recommendation given by the cardiologist.
There is also a debate in medical circles about whether only a questionnaire is needed and “false positives” could become a problem with too much screening. A separate debate is going on about dealing with players of African descent having a higher risk of heart problems.
After the death of Marc-Vivien Foé in 2003, Fifa’s head doctor made recommendations to prevent fatalities in 2005 and introduced pre-tournament medical assessments at the World Cup in 2006.
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Fifa estimated in 2009 that 90 per cent of deaths have happened either during training sessions or matches.