Cardiac Screening in relation to Sudden Cardiac Death:

Sudden Cardiac Death (SCD)/Sudden cardiac arrest is the sudden cessation of cardiac activity so that
the victim becomes unresponsive, with no normal breathing and no signs of circulation. If corrective
measures are not taken rapidly, this condition progresses to sudden death.

The HSE commissioned a report reviewing all sudden cardiac deaths between January 2005 and
December 2007. The report included those between the ages of 15-35. Out of 292 cases reviewed,
119 met the criteria for SCD and were included in the report 2 . Therefore over a period of 3 years, 40
people per annum (nearly one per week) in the 15-35yr age group were dying of SCD. The HSE
report describes an incidence of SCD among those aged 15-35 years in the Republic of Ireland was
2.68 per 100,000 / yr . The incidence rates in this report may “ be an underestimation of the true
figure due to missing or inadequate data resulting in case exclusions”. Incidentally, the HSE report
describes the ratio of male to female deaths as approximately 2:1 for SADS 2 .

There is increasing awareness of SCD among all the main sporting bodies particularly in Ireland and
this may be due to the fact that Ireland appears to have a higher incidence of SCD than in other
European countries. For instance, the overall incidence of SCD is estimated at 0.93/100,000 in
Sweden from 1992-1999 3 and 1.47/100,000 in Iceland whereas in Ireland it equates to
2.68/100,000 2 .

World Rugby has endorsed but not mandated cardiac screening for all athletes participating in rugby
either in a professional or non-professional context. The following are recommendations for
community rugby teams:

“The World Rugby recommendations regarding cardiac screening for Community Rugby are:
1. Cardiac screening is recommended for players between ages 14 and 35⁶ who participate in a
regular Rugby competition or a structured Tournament and should as a minimum include a
cardiac screening questionnaire. The World Rugby Cardiac Screening questionnaire which is
presented as a base cardiac questionnaire is available on line at
worldrugby.org/playerwelfare
2. Repeat cardiac screening is ideal every 2 years for athletes under 20 years of age. For all
athletes, cardiac screening is recommended if at any time cardiac symptoms develop or
become evident.
3. An athlete answering YES to any question in the cardiac screening questionnaire should
discuss the finding with their family doctor.
4. For athletes less than 18 years of age, the cardiac screening questionnaire should be
completed under the supervision of or in conjunction with a parent or guardian 3 .”
In 2010, the GAA outlined the organisations position on cardiac screening via the Medical, Scientific
and Welfare Committee following their own research based on 300 GAA players where the
examined the effectiveness of screening methods. They concluded, “Following consideration of the
results of the GAA’s research programme and the most up-todate international best practice
guidelines, the Medical, Scientific and Welfare Committee of the GAA have advised that the most
effective way to identify potential risk is for players over the age of 14 to undergo cardiac screening
on one occasion. It is also advised that this process be repeated before the age of 25” 4 .
The FAI, have encouraged all young players to fill out the online questionnaire in relation to cardiac
screening and seek further advice from their general physicians where a positive response occurs.

Frequently asked questions

What is Cardiac Screening?
Cardiac screening is a process whereby each participant will undergo 4 key stages.
1. Completion of focused questionnaire
2. Height/Weight measurement
3. Electrocardiography (ECG)
4. Focused cardiovascular consultation by a doctor and review of the ECG

What happens after Cardiac Screening?

Results are reviewed by a Consultant Cardiologist and any findings, positive or negative are
documented and the results will be shared with the individual being screened in a timely fashion.
Where will the Cardiac Screening happen?
We will design a package that suits your individual needs. This can include attending the
club/workplace to facilitate an onsite screening clinic at a time that best suits your needs.
Otherwise we can facilitate a screening clinic in a local and comfortable surrounding which is easily
accessible.

How long will it take?

We will use Lean methods to ensure that your experience is a positive and smooth affair. The cardiac
screening process can take from 25-

Can I be screened if I am under 18 yrs. of age?

Yes, the aforementioned guidelines (World Rugby/FAI/GAA) recommend that adolescents 14 yrs. or
older are screened for cardiac abnormalities. If you are <18yrs of age, then parents must accompany
their children to the screening as consent will be required from a parent/guardian.

I do not know my family history?

It is important that you discover from parents or siblings or relatives the relevant family history as
the following question will be asked in the questionnaire. Do you have a brother, sister, cousin,
parent or grandparent who died suddenly and unexpectedly under 45 years of age due to heart
disease or no known cause?

Does Cardiac Screening identify all athletes with SCD?

Unfortunately, the answer is no. Cardiac screening will not identify 100% of abnormalities but it is
the most effective and non-invasive method of screening patients as endorsed by the European
Society of Cardiology.

What is the cost of Cardiac Screening:

€75 per screening. This includes height & weight, ECG, consultation with a doctor onsite, review of
results by a consultant cardiologist.

References:
1. Www-uptodate-com.proxy.library.rcsi.ie. (2019). RCSI Library off-campus access to
electronic resources . [online] Available at:
https://www-uptodate-com.proxy.library.rcsi.ie/contents/overview-of-sudden-cardiac-ar
rest-and-sudden-cardiac-death?search=cardiac%20screening&source=search_result&sel
ectedTitle=2~150&usage_type=default&display_rank=2 [Accessed 6 Mar. 2019].
2. Hse.ie. (2019). [online] Available at:
https://www.hse.ie/eng/services/publications/topics/heart/sdcyoung.pdf [Accessed 6
Mar. 2019].
3. Playerwelfare.worldrugby.org. (2019). World Rugby Player Welfare – Putting Players First :
World Rugby Cardiac Screening . [online] Available at:
https://playerwelfare.worldrugby.org/?documentid=4 [Accessed 6 Mar. 2019].
4. Learning.gaa.ie. (2019). [online] Available at:
https://learning.gaa.ie/sites/default/files/Player/Position%20Paper%20-%20Cardiac%20S
creening%20-%202010.pdf [Accessed 6 Mar. 2019].
Author:
Dr John Byrne
March 2019
IMC 327386