Objective To investigate the underlying causes and regional patterns of sudden death in football (soccer) players worldwide to inform and improve existing screening and prevention measures.
Methods From 2014 to 2018 cases of sudden cardiac death (SCD), survived sudden cardiac arrest (SCA) and traumatic sudden death were recorded by media monitoring (Meltwater), a confidential web-based data platform and data synchronisation with existing national Sudden Death Registries (n=16). Inclusion criteria were met when sudden death occurred during football-specific activity or up to 1 hour afterwards. Death during other activities was excluded.
Results A total of 617 players (mean age 34±16 years, 96% men) with sudden death were reported from 67 countries; 142 players (23%) survived. A diagnosis by autopsy or definite medical reports was established in 211 cases (34%). The leading cause in players >35 years was coronary artery disease (76%) and in players ≤35 years was sudden unexplained death (SUD, 22%). In players ≤35 years the leading cause of SCD varied by region: cardiomyopathy in South America (42%), coronary artery anomaly in North America (33%) and SUD in Europe (26%). Traumatic sudden death including commotio cordis occurred infrequently (6%). Cardiopulmonary resuscitation (CPR) resulted in a survival rate of 85% with the use of an automated external defibrillator (AED) compared with 35% without.
Conclusions Regional variation in SCD aetiology should be verified by expansion of national registries and uniform autopsy protocols. Immediate access to an AED at training and competition sites, as well as CPR training for players, coaches and staff members, is needed to improve survival from SCA.
- heart disease
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Contributors TM, JS and JD designed the study. FE, TM, JS, AK and PB collected data. FE analysed the data and drafted the manuscript. All authors contributed to the final manuscript.
Funding This work was funded by F-MARC (FIFA Medical Assessment and Research Centers). Financial support enabled Saarland University to cover the expenses for two main areas: (1) yearly subscription fees for the use of the media search application provided by the Meltwater company; (2) reasonable compensation for the work undertaken by a physician running this registry on a daily basis.
Disclaimer None of the authors were in any way employed by the funding institution. There was no ethical conflict or any unwanted guidance. All authors can take responsibility for the integrity of the data.
Competing interests TM is chairman of the Medical Committee of the German FA and UEFA. JD is former chairman of F-MARC. All authors declare that they have no competing interests regarding the aims of the study.
Patient consent for publication Not required.
Ethics approval This study was approved by the ethics committee and by the independent Data Protection Centers Saarland, Germany (approval number 172/11).
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement No data are available.
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