Universal cardiac testing 'not practical'

THE GAA have given more details on their policy of not providing full cardiac screening for senior inter-county players. According to Dr Pat Duggan, chair of the Medical, Scientific & Welfare Committee, which next week launches its new player welfare booklet, there is no consensus in medicine as to best practice in preventive strategies.

"The international community is divided as to the most effective form of screening," he said. "In the US they favour a simpler approach, completing questionnaires, but in Italy they favour more intensive methods, such as ECG and echo screening.

"There have been suggestions that the GAA should follow the latter example in screening all intercounty players. But there are tens of thousands that play at a high level with their clubs and face the same risks. The demands of their training put them in that category as well. It's illogical to maintain that intercounty panels have a significantly higher risk than other adult categories.

"My view is that we should screen everybody or screen nobody and it's not practical to implement a universal programme and we have to work within that reality. For example, the incidence of sudden cardiac arrest is between one in 200,000 and one in 300,000 in the below-35 demographic but once you go over the age of 35 this risk is 40 times greater. Should the GAA concentrate on screening older players who have 40 times greater a chance of being affected?

"The downside to intensive screening is that 40 per cent could end up needing further screening and the health service, on top of all its other problems, isn't equipped for that. And even with the most advanced screening available the pick-up rate may be only 50 per cent of those at risk. There are, for instance, viral infections, drug-induced episodes and electrical disturbances that won't show up in the screening."

The GAA screening process is based on questionnaires detailing family history and other data.

"Everyone over 14 fills in the questionnaire," says Duggan, "and anyone who fills in a positive should have themselves assessed. We believe that a positive questionnaire may be the closest predictor to the risk of sudden death."

The committee is awaiting the conclusion, due within weeks, of its survey of 400 intercounty players.

The GAA's policy on cardiac screening was arrived at after two years of canvassing opinions and considering the report of a Department of Health work group, which examined the area.

"The GAA is the first sports organisation in Ireland to adopt a position paper on cardiac screening," says Duggan. "We have been two years getting a consensus on the matter.

"We're satisfied that it's a good model and in fact the FAI have copied it word for word."

Within the association the issue has been given a high profile by the sudden death of then Tyrone captain Cormac McAnallen, whose family have campaigned for greater awareness of the need for cardiac screening and the widespread availability of defibrillators and in whose memory the Cormac Trust was established for the advancement of those aims.

Duggan believes the raising of the profile of heart problems among young people has contributed greatly to the publicity now given to incidents of that nature.

He does not feel these incidents have actually increased or the physical demands on modern players have increased the frequency of these episodes.

"In my personal opinion there is no evidence that the greater intensity of training methods is in any way linked to cardiac risk. If you were to look at what are the most reliable clues, they would be family history."

Outside of family history and established indicators such as high blood pressure there are other possible contributory factors.

"There has been a lot of speculation on the use of supplements," says Duggan. "In the US you had the case of ephedra, a stimulant which was conclusively proved to be involved in cardiac events.

"The supplement industry is a multi-billion-dollar industry and use of supplements is widespread. Then there is greater experimentation with social drugs, such as cocaine, which also has a risk factor."

The booklet to be launched next week will draw together work done by the committee in various areas.

In relation to cardiac health Duggan hopes to have access to the data from the current survey soon.

"The survey of intercounty players should be completed within the next three to four weeks. Our term of office is up in just under 12 months so we will want to have the survey ready in advance of that. It's all part of a process."