Kentaro Yamagata, Sanjay Sivalokanathan, Gherardo Finocchiaro, Raghav T Bhatia, Dan Augustine, Michael Bowes, Daniel Broman, Paul Clift, Robert M Cooper, Antoinette Kenny, Ritan Mehta, David Oxborough, Michael Papadakis, Kiran Patel, Dhrubo Rakhit, David Ripley, Tristan Ramcharan, Georgina K Stebbings, Amanda M Varnava, John Walsh, Zaheer Yousef, Jamie S McPhee, Charlotte M Cowie, Sanjay Sharma, Aneil Malhotra
Cardiovascular screening in elite female football players identified a low prevalence of major cardiac conditions, predominantly electrical disorders, with no cardiomyopathy diagnosed at baseline and no SCA/SCD during follow-up. As female participation in elite sport continues to grow, these findings support the need for sex-appropriate interpretation and adequate budgeting for pre-participation cardiovascular evaluation.
OBJECTIVE: To investigate the results of cardiac screening, prevalence of cardiac diseases and subsequent health outcomes among elite female football players in the UK.
METHODS: Between 2000 and 2024, 3121 elite female football players underwent the English Football Association (FA) cardiac screening programme, comprising a health questionnaire, 12-lead ECG and echocardiogram. The FA registry was interrogated for screening findings, subsequent testing, diagnosis and cardiac morbidity or mortality, including sudden cardiac arrest and death (SCA/SCD). Sex-based comparisons were performed in 2680 females screened between 2017 and 2024, matched 1:2 by age, ethnicity and screening period to 5360 male players screened through the same programme.
RESULTS: Female athletes were 19.8±5.4 years old, and the majority (87%) were White. Among 3121 female football players, 193 (6.2%) had an abnormal screening result requiring further evaluation; positive health questionnaires were present in 321 (10.3%), of which two (0.6%) athletes were true-positive for major cardiac conditions. Abnormal ECGs were present in 77 (2.5%), of which four (5.2%) were true positives. Major cardiac conditions were diagnosed in six (0.2%), including four with long QT syndrome, one with Wolff-Parkinson-White syndrome and one with bicuspid aortic valve with moderate to severe aortic regurgitation. No female had cardiomyopathy diagnosed at baseline; however, one (0.03%) was diagnosed with arrhythmogenic cardiomyopathy 18 months later. During 19 193 person-years of follow-up, no female experienced SCA/SCD. In matched analysis, major cardiac conditions were diagnosed in five females (0.2%) and 29 males (0.5%; p=0.027), with higher estimated screening expenditure per major diagnosis in females (£146 809 vs £51 888).
CONCLUSIONS: Cardiovascular screening in elite female football players identified a low prevalence of major cardiac conditions, predominantly electrical disorders, with no cardiomyopathy diagnosed at baseline and no SCA/SCD during follow-up. As female participation in elite sport continues to grow, these findings support the need for sex-appropriate interpretation and adequate budgeting for pre-participation cardiovascular evaluation.