The Aquatic Sports Association of Malta and PSMC (Malta) have entered into an agreement to screen the water polo and swimming national team athletes for cardiac health. For the past 6 years, PSMC has been entrusted with providing sports medicine and physiotherapy services to all the national team athletes selected by the ASA.

A seminar purposefully organised to launch the pre-participation athlete cardiac screening programme was addressed by Joe Caruana Curran – President of the ASA, Dr John Xerri de Caro – Managing Partner of PSMC (Malta) and Dr Mark Abela who presented the medical implications for cardiac screening. PSMC (Malta) introduced its latest product PPaCs – a pre-participation athlete cardiac screening program - a 1st level screening for cardiac health and heart anomalies in athletes, with the intention of identifying high risk individuals at risk of sudden death.

Following this screening the athletes are assured that their well being is a priority, be it by means of preventive medicine or active management.

Cardiac adaptations due to highly strenuous activity, specifically termed athletic adaptations, help athletic individuals adapt to the vigorous exercise regimes and training conditions they are subjected to. Specifically, a number of different forms of adaptation have been reported, including sinus bradycardia in 50-60% of athletes, with bigger heart chambers and thicker heart muscle layers reported in 41-48% of endurance athletes1.

Of the 17 million cardiac related deaths each year, 25% are sudden deaths2 . Whilst sudden cardiac death in young adults is a rare event, young athletes below the age of 35 years are at a higher risk of sudden death during competitive sport when compared to the general population3.

Such deaths are reported to occur in 0.54 to 135 per 100,000 athletes each year with more than 80% of these occurring without pre-warning symptoms. 

All this evidence suggests that earlier identification of high risk athletes is of paramount importance. Sudden cardiovascular related deaths in young competitive athletes in Italy was significantly reduced following the implementation of a pre-participation screening program6 to a level lower than that of unscreened non-athletes. Cardiac screening is easy and noninvasive, with its proven efficacy highlighting the feasibility for systematic screening. The medical and family history, in conjunction with a physical examination and electrocardiogram helps sport physicians identify individuals who need secondary evaluation. The majority of these will be reassurred, some will need serial evaluations, and some may be diagnosed with heart disease and would need regular follow ups. Importantly, the evidence from large scale screening cohorts suggests that only a limited number of athletes will be advised to stop competitive sports. On behalf of PSMC, Dr Xerri de Caro explained that PPaCs will enable the athlete to have a comprehensive cardiac evaluation. PPaCs involves a three point assessment system, that is designed on the recommendations of the European Society of Cardiology for athletes between the ages of 14 and 35 years.

The assessment includes an examination by a cardiologist, a detailed analysis of the athlete’s personal and familial history, as well as a 12- point ECG carried out at rest. In addition, PPaCs will allow for the athlete to be screened for musculoskeletal anomalies by a physiotherapist. Athletes above 35 years will undergo the same protocol which would include a stress test, as coronary artery disease is the most common cause of heart problems in this age group. This assessment shall lead to the athlete being certified as “fit-to-participate” in highly strenuous activities or, in the presence of significant findings, being referred for secondary evaluation that intends to identify the main cardiac pathology, risk stratify, and institute preventive treatment options if necessary, so as to decrease risk. Joe Caruana Curran, ASA President acknowledged that this service for the ASA athletes was highly important as it sought to reassure parents, coaches, club administrators and the athletes themselves of their fitness to participate.

Aware that in countries like Italy and the Balkans where aquatic sports is of world class level and that athletes must be in possession of a “fit-to-participate” certification in order to compete, he hoped that this would send a positive message to local clubs. The ASA was indeed conscious of its importance and has been in discussions with PSMC for some time in order to better understand the implication and ramification of such screening. Strengthened by the resolve that this is a very important consideration for the ASA, he pledged the Association’s intention to lead by example by funding the screening of all of its national team athletes, thus putting the ASA together with PSMC at the forefront of Malta’s sport regulating bodies and sports medicine providers, in implementing high standards of practice to ensure their athlete’s safety.