Original research| Volume 25, ISSUE 4, P287-292, April 2022

Results of a nationally implemented cardiac screening programme in elite cricket players in England and Wales

Published:December 07, 2021DOI:



      We assessed the diagnostic yield and costs of an electrocardiogram-based national screening programme in elite cricket players and the incremental value of transthoracic echocardiography and periodic evaluation.


      Cross-sectional study.


      Between 2008 and 2019, 1208 cricketers underwent screening with a health questionnaire, 12-lead electrocardiogram and cardiology consultation. Athletes with concerning findings underwent on-site transthoracic echocardiography and further investigations as necessary. In addition, despite a normal health questionnaire and electrocardiogram, 342 (28.3%) athletes had a transthoracic echocardiogram and 493 (40.8%) underwent repeat evaluations.


      After initial evaluation, 47 (3.9%) athletes underwent on-site transthoracic echocardiography of whom 35 (2.8%) were referred for further evaluation. Four athletes (0.3%) were diagnosed with major cardiac conditions; hypertrophic cardiomyopathy (n = 1), arrhythmogenic cardiomyopathy (n = 1) and Wolff-Parkinson-White pattern (n = 2). Two athletes were identified with minor valvular abnormalities. Repeat evaluation of 493 athletes identified hypertrophic cardiomyopathy in a 22-year-old athlete, two years after his initial normal screening. During a follow-up of 5.8 ± 2.9 years no additional diagnoses or adverse cardiac events were reported. The cost of the electrocardiogram-based programme was £127,844, translating to £106 per athlete and £25,569 per major cardiac condition identified.Routine transthoracic echocardiography in 342 athletes identified two athletes with major cardiac conditions (bicuspid aortic valve with severe aortopathy and aortic regurgitation and an atrial septal defect associated with right ventricular volume overload) and 10 athletes with minor abnormalities.


      An electrocardiogram-based national screening programme identified a major cardiac condition in 0.3% of athletes. Routine transthoracic echocardiography and periodic evaluation increased the diagnostic yield to 0.6%, at an incremental cost.


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        • Harmon K.G.
        • Asif I.M.
        • Maleszewski J.J.
        • et al.
        Incidence, cause, and comparative frequency of sudden cardiac death in national collegiate athletic association athletes a decade in review.
        Circulation. 2015; 132: 10-19
        • Dvorak J.
        • Grimm K.
        • Schmied C.
        • et al.
        Development and implementation of a standardized precompetition medical assessment of international elite football players-2006 FIFA world cup Germany.
        Clin J Sport Med. 2009; 19: 316-321
        • Ljungqvist A.
        • Jenoure P.
        • Engebretsen L.
        • et al.
        The International Olympic Committee (IOC) consensus statement on periodic health evaluation of elite athletes March 2009.
        Br J Sports Med. 2009; 43: 631-643
        • Corrado D.
        • Pelliccia A.
        • Bjørnstad H.H.
        • et al.
        Cardiovascular pre-participation screening of young competitive athletes for prevention of sudden death: proposal for a common European protocol - consensus statement of the Study Group of Sport Cardiology of the Working Group of Cardiac Rehabilitation an.
        Eur Heart J. 2005; 26: 516-524
        • Grazioli G.
        • Merino B.
        • Montserrat S.
        • et al.
        Usefulness of echocardiography in preparticipation screening of competitive athletes.
        Rev Española Cardiol (Engl Ed). 2014; 67: 701-705
        • Mitchell A.R.J.
        • Hurry R.
        • Le Page P.
        • et al.
        Pre-participation cardiovascular screening: is community screening using hand-held cardiac ultrasound feasible?.
        Echo Res Pract. 2015; 2: 49-55
        • Wyman R.A.
        • Chiu R.Y.
        • Rahko P.S.
        The 5-minute screening echocardiogram for athletes.
        J Am Soc Echocardiogr. 2008; 21: 786-788
        • Pelliccia A.
        • Caselli S.
        • Sharma S.
        • et al.
        European Association of Preventive Cardiology (EAPC) and European Association of Cardiovascular Imaging (EACVI) joint position statement: recommendations for the indication and interpretation of cardiovascular imaging in the evaluation of the athlete’s heart.
        Eur Heart J. 2018; 39: 1949-1969
        • D’Ascenzi F.
        • Anselmi F.
        • Mondillo S.
        • et al.
        The use of cardiac imaging in the evaluation of athletes in the clinical practice: a survey by the Sports Cardiology and Exercise Section of the European Association of Preventive Cardiology and University of Siena, in collaboration with the European Association of Cardiovascular Imaging, the European Heart Rhythm Association and the ESC Working Group on Myocardial and Pericardial Diseases.
        Eur J Prev Cardiol. 2020; 28 (2047487320932018): 1071-1077
        • Sharma S.
        • Drezner J.A.
        • Baggish A.
        • et al.
        International recommendations for electrocardiographic interpretation in athletes.
        J Am Coll Cardiol. 2017; 69: 1057-1075
        • Corrado D.
        • Pelliccia A.
        • Heidbuchel H.
        • et al.
        Recommendations for interpretation of 12-lead electrocardiogram in the athlete.
        Eur Heart J. 2010; 31: 243-259
        • Sheikh N.
        • Papadakis M.
        • Ghani S.
        • et al.
        Comparison of electrocardiographic criteria for the detection of cardiac abnormalities in elite black and white athletes.
        Circulation. 2014; 129: 1637-1649
        • Oxborough D.
        • Augustine D.
        • Gati S.
        • et al.
        A guideline update for the practice of echocardiography in the cardiac screening of sports participants: a joint policy statement from the British Society of Echocardiography and Cardiac Risk in the Young.
        Echo Res Pract. 2018; 5: G1-G10
        • NHS England
        NHS England ≫ National Tariff for 2017/18 and 2018/19.
        • Dhutia H.
        • Malhotra A.
        • Gabus V.
        • et al.
        Cost implications of using different ECG criteria for screening young athletes in the United Kingdom.
        J Am Coll Cardiol. 2016; 68: 702-711
        • Williams E.A.
        • Pelto H.F.
        • Toresdahl B.G.
        • et al.
        Performance of the American Heart Association (AHA) 14-point evaluation versus electrocardiography for the cardiovascular screening of high school athletes: a prospective study.
        J Am Heart Assoc. 2019; 8e012235
        • Harmon K.G.
        • Suchsland M.Z.
        • Prutkin J.M.
        • et al.
        Comparison of cardiovascular screening in college athletes by history and physical examination with and without an electrocardiogram: efficacy and cost.
        Heart Rhythm. 2020; 17: 1649-1655
        • Malhotra A.
        • Dhutia H.
        • Finocchiaro G.
        • et al.
        Outcomes of cardiac screening in adolescent soccer players.
        N Engl J Med. 2018; 379: 524-534
        • Orchard J.J.
        • Orchard J.W.
        • La Gerche A.
        • et al.
        Audit of a cardiac screening policy for elite Australian cricketers.
        J Sci Med Sport. 2020; 23: 541-547
        • Abergel E.
        • Chatellier G.
        • Hagege A.A.
        • et al.
        Serial left ventricular adaptations in world-class professional cyclists: implications for disease screening and follow-up.
        J Am Coll Cardiol. 2004; 44: 144-149
        • Papadakis M.
        • Carre F.
        • Kervio G.
        • et al.
        The prevalence, distribution, and clinical outcomes of electrocardiographic repolarization patterns in male athletes of African/Afro-Caribbean origin.
        Eur Heart J. 2011; 32: 2304-2313
        • Leslie L.K.
        • Cohen J.T.
        • Newburger J.W.
        • et al.
        Costs and benefits of targeted screening for causes of sudden cardiac death in children and adolescents.
        Circulation. 2012; 125: 2621-2629
        • Ghani S.
        • Papadakis M.
        • Kemp S.
        • et al.
        Results of a nationally implemented de novo cardiac screening programme in elite rugby players in England.
        Br J Sports Med. 2016; 50: 1338-1344
        • Austin A.V.
        • Owens D.S.
        • Prutkin J.M.
        • et al.
        Do ‘pathologic’ cardiac murmurs in adolescents identify structural heart disease? An evaluation of 15 141 active adolescents for conditions that put them at risk of sudden cardiac death.
        Br J Sports Med. 2021; (bjsports-2019-101718)
        • Norrish G.
        • Jager J.
        • Field E.
        • et al.
        Yield of clinical screening for hypertrophic cardiomyopathy in child first-degree relatives.
        Circulation. 2019; 140: 184-192