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Results of a nationally implemented de novo cardiac screening programme in elite rugby players in England
  1. Saqib Ghani1,
  2. Michael Papadakis1,
  3. Simon Kemp2,
  4. Abbas Zaidi1,
  5. Nabeel Sheikh1,
  6. Sabiha Gati1,
  7. Hariharan Raju1,
  8. Andy Smith3,4,5,
  9. Corin Palmer5,
  10. John Somauroo6,7,
  11. Sanjay Sharma1
  1. 1Cardiovascular Sciences Research Centre, Cardiovascular and Cell Sciences Research Institute, St George's University of London, London, UK
  2. 2Rugby Football Union, Middlesex, UK
  3. 3Mid Yorkshire Hospital NHS Trust, Wakefield, UK
  4. 4RWC England 2015 Medical Advisory Group
  5. 5Premiership Rugby, Twickenham, UK
  6. 6Countess of Chester NHS Hospital Trust, UK
  7. 7Liverpool Heart and Chest NHS Hospital Trust, Liverpool, UK
  1. Correspondence to Professor Sanjay Sharma, Cardiovascular Sciences Research Centre, Cardiovascular and Cell Sciences Research Institute, St George's University of London, Cranmer Terrace, London SW17 0RE, UK; ssharma21{at}


Background/aim Screening of young competitive athletes remains a contentious issue. In 2010, a nationwide cardiac screening for all elite rugby players was introduced in England. This provided a unique opportunity to prospectively assess the feasibility and cost-effectiveness of a de novo, ECG-based cardiac screening programme.

Methods Between 2010 and 2012, 1191 rugby players aged ≥14 years underwent cardiac screening with a health questionnaire, 12-lead ECG and a consultation with a cardiologist. The players with concerning findings on initial evaluation were offered on-site transthoracic echocardiogram (TTE). Athletes were referred for further investigations as deemed necessary. The overall cost of the screening programme was estimated.

Results After initial evaluation, 9.7% of athletes underwent on-site TTE; 8.2% underwent on-site TTE due to ECG anomalies and 1.4% underwent on-site TTE due to concerns on the questionnaire. After TTE, only 2.9% of the total cohort was referred for further evaluation. Two players were diagnosed with potentially serious conditions; one with Wolff-Parkinson-White, who resumed competition after catheter ablation, and one with hypertrophic cardiomyopathy, who withdrew from competition. During a mean follow-up of 52.8±5.5 months, none of the players who were reassured experienced any adverse cardiac events. The total cost of the screening programme was £59 875, which averaged to a cost of £50 per player or £29 938 per condition identified. Application of refined ECG criteria would reduce the ECG false-positive rate to 4.9%.

Conclusions Preparticipation cardiac screening with 12-lead ECG is feasible. Refinement of the ECG criteria, the use of on-site TTE and expert setting can minimise the burden of unnecessary investigations and reduce costs.

  • Athlete's heart
  • Cardiovascular
  • Rugby

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  • Contributors SG, MP, AZ, NS, SG, HR, JS helped with data collection; SG and MP analysed the data and led the manuscript-writing process with contribution from others. SK, AS and CP facilitated the screening events; SS supervised the overall study and reviewed the manuscript. All authors approved the final manuscript.

  • Competing interests SG, MP, AZ, SG, NS, HR were funded by a research grants from the charitable organisation Cardiac Risk in the Young (CRY), which supports pre-participation screening of young athletes. SS has been a coapplicant on previous grants from CRY to study athletes.

  • Ethics approval National Research Ethics Service, Essex 2 Research Ethics Committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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