15 August 2018

Elite athletes run a greater risk than others of suffering from cardiac arrest. Still, a study in Östergötland shows that many sports clubs do not follow the Swedish Sports Confederation’s recommendations regarding cardiovascular screening.

Large group of muscular cycling triathlon competitors Photo credit: HasseChrIn June, the British Journal of Sports Medicine published an article by five LiU researchers from the Department of Medical and Health Sciences, entitled “From guidelines to the sidelines: implementation of cardiovascular preparticipation evaluation in sports club is lagging”.Kristofer Hedman, porträttKristofer Hedman, researcher and specialist in clinical physiology Photo credit: Gunilla Pravitz

“Of course, it’s big news in the sports world when an elite athlete suddenly collapses and dies during intensive physical exertion”, says the principal author of the article, Kristofer Hedman, specialist in clinical physiology and researcher at LiU’s Department of Medical and Health Sciences.

“It rarely happens. But with cardiovascular screening you can see who is at risk of cardiac arrest. Amongst elite athletes below 35 years of age, the cause is most often congenital or hereditary cardiovascular disease, while those over 35 have more often developed coronary disease.”

There are international recommendations regarding cardiovascular screening of elite athletes between 16 and 35 years of age, and the Swedish Sports Confederation follows similar guidelines.
“There were suspicions that sports clubs weren’t always following the recommendations for the screening of elite athletes. We wanted to find out if this was true, and decided to start here at home. So we developed a study based on an electronic questionnaire that was sent to every sports club in the region of Östergötland”, says Kristofer Hedman.

As suspected, the study found that far too few screenings are carried out.
“Just 4 of 22 clubs in Östergötland that reported that they had elite athletes said they followed the recommendations, excluding clubs that represented team sports and had access to team doctors.”

Just over five per cent of the clubs followed the guidelines.
“The proportion is probably even lower. Not every club responded, and one could probably assume that their elite athletes aren’t screened. These are discouraging figures, and there is no reason to believe that other clubs around the country are any different from the clubs we studied here in Östergötland”, says Kristofer Hedman.

From a statistical point of view, few elite athletes suffer cardiac arrest: one to three individuals per 100,000, annually. But these are deaths that in most cases could be avoided by regular cardiovascular screening, which can identify risks at the individual level.

Why do so few sports clubs follow the recommendations for screening, when it saves lives? After all, in the sports world, all sorts of testing is done to prevent injuries.
Kristofer Hedman explains that the reasons vary:
“First of all, it’s not that easy to define which athletes are considered ‘elite’. And secondly, at which level should we put the responsibility for screening? With the clubs, or the various sports associations?”
In their report, the researchers maintain that clearer information from the Swedish Sports Confederation would be helpful.
“For instance, of the 22 clubs who responded to our questionnaire, 7 stated that they didn’t even know that there were recommendations for screening. And 8 are unsure of what to do in practice. Furthermore, many are unfamiliar with the financial particulars of having a screening; it is done at cost price at a heart clinic.”

The research results were first published in an article in Läkartidningen, a Swedish medical journal.
In Sweden such a study had not been carried out, and internationally there have been few. Therefore the article which was published as an editorial in the British Journal of Sports Medicine in June has aroused interest in sports cardiology and in various parts of the research world.

“For us, the most important thing now is that this knowledge reaches experts in sports medicine, and filters down to clubs and athletes. Because we can have all sorts of excellent guidelines and directives, but if they’re not followed, they’re pointless”, says Kristofer Hedman.

The article: “From guidelines to the sidelines: implementation of cardiovascular preparticipation evaluation in sports clubs is lagging”, Kristofer Hedman,
Sofia Sunnerud, Anna Carlén, Magnus Janzon, Eva Nylander, Br J Sports Med (editorial), published online June 19 2018, doi: 10.1136/bjsports-2018-099297

Article in Läkartidningen (in Swedish)

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