Football: "We want to globally determine deaths for the first time"

Interview with Dr. Jürgen Scharhag, Institute of Sports and Preventive Medicine , Saarland University

Sudden deaths of football players make headlines time after time: competitive athletes who are the idols of many people die just when they are on the playing field and in the limelight. Congenital heart defects often cause their death. Sports physicians and FIFA now plan to ascertain data that can help improve preventive examinations in competitive football.


Photo: Physician with short black hair and white coat - Dr. Jürgen Scharhag; Copyright: private

Dr. Jürgen Scharhag; © private

Just in time for the football World Championship 2014 in Brazil, talked with Dr. Jürgen Scharhag about FIFA-SDR – Sudden Death in Football. It is a registry for cases of sudden death in football around the world. Scharhag and his colleagues at the Saarland University will launch the register during the next five years in cooperation with the FIFA Medical Assessment & Research Center (F-MARC).

Dr. Scharhag, in a cooperative effort, FIFA and the Saarland University are creating a global registry of football-related sudden death cases. What actually is "sudden death" in sports?

Jürgen Scharhag: This is death while you are engaged in a sport activity, both during competition and amateur sports or up to one hour after exercise.

The most common cause is sudden cardiac death. The distinction here is between athletes under the age of 35 and those that are older. The younger athletes under 35 normally have a congenital heart defect. The older ones on the other hand are likely to suffer from coronary heart disease, meaning a coronary artery restriction. In approximately 80 percent of fatalities with the older athletes, typically previously unknown coronary heart disease can be detected. Generally, the cause of death in this case is a myocardial infarction.

In addition, serious injuries are of course also possible causes for sudden deaths.

What is the goal of the registry?

Scharhag: We want to globally determine football-related deaths for the first time and actually be able to evaluate the risk for sudden deaths. "Is there a particularly high or generally specific risk in football for sudden death and notably sudden cardiac death?" This is a question we are trying to answer. Based on the collected data, we can contribute to improve preventive medical examinations if need be. In doing so, we are able to deduce for countries where there are no screenings for athletes for instance whether resting ECGs, exercise ECGs or echocardiograms should be included in prevention programs.
Photo: Entry from of a homepage; Copyright: Saarland University

This is the entryform of the FIFA-SDR - Sudden Death in Football; ©Saarland University

Which data do you want to collect for this purpose?

Scharhag: The Internet-based data acquisition is relatively simple. Among other things, we ask for the athlete’s age bracket and his classification – whether he is a hobby athlete, competitive athlete, an elite or professional athlete. Should important information be missing, after notification we need to inquire for instance whether the athlete had a congenital heart defect or whether the heart disease was more age-related. The data collection is anonymous and we are dependent on the cooperation of colleagues worldwide.

The Saarland University has operated such a registry for almost two years for Germany. What insights were you able to gain from it so far?

Scharhag: Football is the leader in Germany as it pertains to the reported deaths. So far, that is 20 out of 73 total cases. The majority of reported cases originate in the popular leisure and competitive sports. We only received reports about two cases in high performance sports. This is presumably because there are already numerous and very good preventive medical examinations in German competitive or rather high performance sports.

Data for the global registry are not just meant to be collected via an online platform. Certain countries are supposed to be examined specifically and in greater detail. What makes these countries representative?

Scharhag: We are still in the selection stage when it comes to partnership countries. It also depends on the respective infrastructure of the country and the necessary information systems need to be in place there. Football has to be organized and also sufficiently played, so we can gather representative data.

What is more, we want to look for partnership countries in different parts of the world to get a representative picture of all ethnicities. There are differences with regard to heart disease between ethnic groups, which have already been documented with the help of ECGs and echocardiography. However, we are not able to assess these differences relating to risks in sports and particularly for sudden cardiac death just yet.
Photo: Football player motionless on the ground at the playing field; Copyright:

When football players suddenly collapse on the playing field and require resuscitation, tha cause may be a congenital heart defect. The defect may have caused sudden cardiac arrest (iconic picture); © pacoayala

What role can country-specific lifestyle habits outside of football, for instance diet play?

Scharhag: This is potentially a factor. The so-called Mediterranean diet generally seems to be good for the cardiovascular system. Therefore, it is conceivable that sudden deaths in sports in the Mediterranean area have a different frequency of occurrence or a different cause than in countries with a different diet approach – for instance fewer deaths from coronary artery restriction. However, for the time being the goal of our registry is to determine the frequency of football-related sudden deaths and to compare the risk of football-related sudden deaths between different countries.

When do you anticipate the launch of the registry?

Scharhag: The scheduled runtime initially is set for five years. We need to establish the necessary contacts and setup the network for the registry during the first year. We already know many colleagues, who are working in the football area and also at FIFA. There are also FIFA accredited medical centers where experts work in this field. We need to utilize these contacts and establish further ones, because only a good network also enables us to collect representative data.
Photo: Timo Roth; Copyright: B. Frommann

© B. Frommann

The interview was conducted by Timo Roth and translated from German by Elena O'Meara.