Getting to the heart of footballers’ health

Closer to home it prompted his team-mates and colleagues to request extra health checks.

But there was little need. Lessons had already been learned and, for the past few years, the UK has been among those leading the way in preventative heart care for young footballers. “After what happened the players did ask for extra screening and they have been tested again this week,” said Bolton club doctor, Jonathan Tobin.

They weren’t the only ones. Tottenham Hostspur players, who watched on in anguish as the medics tried to shock their opponent back to life, made similar requests according to the London club. The screening included an electrocardiogram (ECG) and echocardiogram (heart scan) as well as the more routine clinical testing of things such as blood pressure.

“There was no medical reason for us to do the tests again as the players are all tested when they sign, and at Premier League level they are tested every two years,” explained Dr Tobin, who, along with other medics, worked for almost an hour on Muamba at the ground and en route to hospital to prevent him slipping away.

“All the Bolton players, including Fabrice [Muamba], were tested in August so there was no medical reason to do it again so soon but we did it again this week purely to give the players reassurance.” The initial view was that for a fit young man – Muamba is just 23 – to collapse so suddenly and unexpectedly, there must have been some pre-existing problem with his heart. Why was it not detected? It certainly wasn’t for the want of trying.

From the age of 16, all kids coming through the professional football academies, and playing for the league clubs down south, testing is mandatory, according to Dr Tobin. There is joint FA/PFA funding mechanism, while Premier League clubs fund their own. “Every club is slightly different. Some have alternative views with regards how often the players should be tested after that. But in general it is believed that they should be screened every two years between 16 and 21 and possibly a little less frequently after that. But the tests are mandatory and the results must be kept in the players’ notes.”

In Scotland the scheme is extensive. For the past four years the Sports Medicine Centre at Hampden has been the home of the Cardiac Assessment in Young Athletes (CAYA) programme.

Following sustained campaigning from the likes of the then Scotland team doctor and renowned cardiologist Professor Stewart Hillis, as well as charities such as HART Scotland, and after the high-profile collapse of Hamilton player Ross McCabe, pictured right, and the sudden death of Phil O’Donnell, this initiative was seen as a massive step forward in preventing similar tragedies. Set up between the Scottish Government, Scottish Football Association and University of Glasgow, it offers cardiovascular screening to all 16-18 year olds participating in sport, whether at amateur or professional level and not just in football.

The screening itself consists of a personal and family history questionnaire, physical examination, resting ECG and an echocardiogram.

“It was set up to see if we could identify that screening in Scotland had the same results as those gained in Italy, where it appeared they could reduce the number of deaths,” said Professor Hillis, a Professor at Glasgow University, who, despite stepping down as national team doctor, remains involved in the research as consultant to the SFA and is also the vice-chairman of the UEFA Medical Committee. “That was the original study and we are in our fourth year of that. The Government’s strategy was that professional sport should be able to do this and pay for it themselves, so their scheme was for the average youngster but the SFA felt that, on a duty of care basis, that had to be extended to professionals so this is the third year of that SFA funding and virtually every one of our league clubs have taken advantage of it and put players through the screening.”

The CAYA programme has eased the minds of around 1,500 youngsters, with NHS staff carrying out group screening in the evenings and at weekends to ensure the system isn’t clogged up, while many of the top-flight clubs opt to do the testing independently of the governing bodies.

“Some clubs do have their own arrangements with local hospitals,” says Hillis, “but that is fine because they are still being screened. The problem is that for some players it remains optional.

“Any club that wants to go into a UEFA competition, then it is manadatory for them. And, as part of the licensing, people with academies must have their folk screened as well but, for other clubs, it is down to individual choice and sometimes we are disappointed.”

The initial research period, funded by the Scottish Government will be ending this year, but Hillis is hopeful that money will be found to extend the programme.

“There is a tiny, tiny chance that, despite screening, you might have something that we can’t detect or do anything about but that really is a tiny, tiny number.”

Muamba appears to have been one of the unlucky few and, despite having been tested, he remains in intensive care. His manager Owen Coyle says that the player continues to make progress and is grateful that medics were able to save him, although the road to recovery remains a long one.

Others have not survived. As well as O’Donnell others have been cut down while playing the game they love, a game their hearts could not withstand. Marc-Vivien Foe was 28 when he died while playing for Cameroon in the Confederations Cup in Paris almost nine years ago. Nigerian under-23 international Endurance Idahor dropped dead of a heart attack in March 2010 and, a few days later, Bartholomew Opuku, a young player from Ghana collapsed in a game and died 24 hours later from a suspected heart attack. Then there was Goran Tunjic, a defender with a lower league Croatian side, who fell to the ground and was dead by the time they got him to hospital. Wilson Mene, a Cambodian footballer, also suffered a heart attack mid-match and died in the ambulance en route to hospital.

Like Muamba, former Celtic midfielder Evander Sno was just 23 when he suffered a heart attack while playing for Ajax and, like the Bolton player, he was saved by the quick response of the club’s medics.

The screening is a financial burden, admits Hillis, but it is not a matter of cost effectiveness, he says, it is down to a duty of care. “In the days of Roger Bannister, athletes would run maybe 11 miles a week, now a promising middle distance runner will run 70-80, while a promising young swimmer will be pounding the waves for hours every day in training.

“The training schedules of our sportsmen and women would have been unheard of years ago and, if we are saying to people that they have to be more active, we also have a duty of care to ensure their hearts are up to it.”