Focus on sudden cardiac death

With an average of five sudden cardiac deaths in Irish sport each year - in the 14-35 age group bracket alone - the GAA's launching of a major initiative to help address the issue will be particularly welcomed. As part of the new Medical, Scientific and Welfare Committee, announced yesterday, all players over the age of 14 are being advised to complete a questionnaire related to cardiac issues, and a highly detailed study of 400 county players - the first of its kind in Ireland - is also being undertaken.

Medical research into sudden cardiac death related to sport is still relatively new, partly because of the relatively rare incidence in people between the ages of 14 to 34 of about one to 250,000 annually. This incidence is 40 times greater in ages over 35, and with the role of defibrillators crucial in prevention in all age groups, the GAA is also increasing the campaign to have such a facility available at every club in the country.

In Croke Park, for example, four such defibrillators are currently in use, and it was highlighted yesterday there were two instances in the past year alone where their use was required, and without which sudden death would most likely have occurred.

The chairman of the new committee is Dr Pat Duggan, the long-serving Dublin team doctor, and he explained why addressing the area of sudden cardiac death was one of the first priorities: "The area is a bit of a minefield in that the more we got into it the harder it was to know where to go. The Government task force produced their own document last autumn, and that was very helpful, but we have pursued this internationally, travelled to the UK and US, to see where they stand.

"We feel the best predictor of sudden death is a questionnaire focusing on family heart history and other symptoms associated with exercise. But there is no differentiation in the risk of a 14-year-old and elite county footballer, so whatever policy we recommend had to be across the board. So everyone from the age of 14 and up should self-administer the questionnaire, which is available from the GAA website, with those up to the age of 21 filling it out with the help of their parents.

"But that's only part one, because there is a lack of scientific consensus in going further in cardiac screening. But we have embarked on a project with Dublin City University to take 400 players, from minor, under-21 and senior, and give them full screening. Part of the problem is that there are genetic differences between, say, the US and Italy, so we would like to take a study of Irish athletes at this level, see what positives, and what pathology we may pick up."

That project is also under way, with the 400 players drawn up in consultation with the GAA's new welfare officer, Paraic Duffy, who has gathered a database of all county players. They will be notified in the coming days, and will feature 260 footballers and 140 hurlers (based on the countywide ratio of 1.4 footballers to every hurler), each of which will attend an hour-long session at Dublin's Mater Hospital. This project will take the best part of the year complete.

"Our main aim is determine the prevalence of cardiac disease and cardiac complications among minor, under-21 and senior players," said Dr Tadgh Crowley, the Kilkenny team doctor and another committee member. "If any abnormality is found it will be discussed with the players, and finally the findings of the study will be presented, and that used going forward. What we've got will shade light on the Irish situation . . ."

The committee is urging all clubs to have a defibrillator facility available (with Dublin club Na Fianna the latest to launch a fund-raising campaign in that regard) and the GAA will assist where possible.

The second major project also under way is the establishment of a player-injury database, now being carried out under the supervision of the UCD School of Physiotherapy and Performance Science - and which sees five football counties and six hurling counties collating injury occurrence on a weekly basis.

"The main goal here is to reduce incidence of injury among players," said John Murphy, the Dublin physiotherapist. "It requires a large amount of co-operation between the counties and UCD, but it is anticipated the existence of such a resource will allow the GAA to look at injury patterns relevant to various training techniques and schedules."

Among the other initiatives to be introduced under the committee will be to improve the overall medical facilities at GAA grounds, the compulsory use of helmets in hurling at senior level by 2009, and the introduction of hepatitis B vaccinations for players.

GAA president Nickey Brennan said cost would not be an issue at any stage of the committee's work: "The only thing we wanted was the best medical advice. It will cost a significant amount of money but we're prepared to make the investment.

"A lot of this involves a high level of collaboration with third-level institutes and their expertise in sports science. We've further initiatives coming down the line, but this is as crucial as the bricks and mortar around the country. There hasn't been much investment, but we're in the stage now where player welfare is high up on our agenda, if not the most important. These are real, serious initiatives that I've no doubt will yield a good return.

"And the sudden-death issue was an obvious priority. In fairness, all this really came to a head after the death of Cormac McAnallen. That's what promoted this whole idea, and the issue certainly hasn't gone away."