Research
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Cardiac screening of
adult GAA players
A study of the GAA cardiac screening programme found that
awareness and uptake among players is worryingly low
The Gaelic Athletic Association (GAA) estimates its total
number of playing teams to be approximately 20,000 with
a player pool of 400,000 to 500,000, of which 19% consists of adult football and 10.3% consists of adult hurling.
Cardiac screening was introduced by the GAA in 2006.
This was launched on the GAA website – www.GAA.ie. The
GAA’s Medical, Scientific and Welfare Committee created
the screening questionnaire, which is downloadable from
the website. Participants who give any positive answers to
the screening questionnaire are advised to see their GP.
Patient advocacy groups including Croí and the National
Sudden Cardiac Death Taskforce play a central role in the
implementation of the screening programme.
This progressive step was taken by the GAA after much
consideration of the medical evidence concerning the benefits of cardiac screening. The topic of cardiac screening in
Ireland has been subject to a large degree of media attention, over the past 10 years in particular. This was after the
sudden deaths of some high profile athletes, particularly
in the GAA.
Initially, in November 2006, a special committee, set-up
to look at protecting the GAA’s players against sudden
cardiac death, recommended that intercounty athletes be
given priority for screening. However, it was advised by the
Taskforce for Sudden Cardiac Death (SCD) that all competitive GAA players should be screened for sudden adult death
syndrome (SADS).
In December 2010, the GAA’s Medical, Scientific and
Welfare Committee reiterated its recommendation that all
players 14 years and above should undergo cardiac screening. However, the type of screening model recommended
was altered. The new model consists of a player filling out
a personal and family history questionnaire, a physical
examination by a medical doctor and an electrocardiogram
(ECG). This is based on the Italian cardiac screening model
– proved effective by Corrado et al.1
Aim
The aim of the study was to determine the awareness and
uptake of cardiac screening among adult playing members
of the GAA.
Objectives
• To assess whether geographical location was a factor in
player awareness and uptake
• To determine the source of player knowledge with regard
to the screening programme
• To assess whether intercounty experience among players
was significant in both exposure and uptake
• To ascertain drop-off rates between player exposure and
actual uptake.
Methods
This is a prospective quantitative observational (STROBE)
descriptive study. A pilot study was performed on four teams
in the Cork area comprising a pool of 67 players.
Permission to perform the project was granted by the
tournament’s host club Kilmacud Crokes GAA Club in
Stillorgan, Co Dublin. This study accumulated data from
playing members of the GAA from Ireland and abroad.
A precoded structured questionnaire was handed face-toface to each project participant. This questionnaire used a
combination of binary and categorical questions. The data
collectors consisted of five medical doctors.
Data was collected on two separate dates, one in a hurling
competition and one in a football competition. Both events
were held in the same venue, in a ‘blitz tournament’ format.
Each competition involved the participation of male adult
playing members of all standards in the GAA.
A total of 880 players were questioned. The collected
data was populated to Microsoft Excel and analysed using
the statistical analysis software SPSS Version 17.
Results
(i) Player population
A cohort of 880 adult playing members of the GAA was
accumulated.
Of these 880 players, 432 had intercounty experience at
minor level or higher, while 448 players had no experience
of playing intercounty.
(ii) Geographical origin of cohort group
Our study group of 880 players originated from all four
provinces and GAA playing members from London. In
particular, Ulster was represented by 300 players (34%).
Leinster accounted for 229 players (26%), while Munster
(220 players, 25%), Connacht (111 players, 13%) and
London (20 players, 2%) comprised the remainder.
(iii) Awareness and completion of cardiac screening
From a total population of 880 players, 258 (29%) were
aware of the GAA Cardiac Screening Programme, while
622 (71%) players were unaware of such a programme.
Sixty-two (7%) players had completed the cardiac screening form, while 818 (93%) players had not completed the
form.
(iv) Source of player awareness
Figure 1 represents the source through which each individual player became aware of the GAA Cardiac Screening
Programme. Of the 258 players who were aware of the proFORUM June 2012 45
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Figure 1
Source of player awareness
Media
Club
Intercounty
Doctor/GP
GPA
Education
Figure 2
Awareness and
completion based on province
%
50
Awareness
Completion
40
30
20
10
0
Munster
Leinster
Connacht
Ulster
gramme, media was found to be the commonest source of
player knowledge (representing 39%). A player’s own club
was found to be the next most common source (32%),
followed by intercounty (19%), a doctor (7%), the Gaelic
Players’ Association (2%) and place of education (1%).
(v) Awareness of cardiac screening based on intercounty
experience
It was found that players who had intercounty experience
were more likely to be aware of the GAA Cardiac Screening
Programme than players with no intercounty experience. A
total of 177 (41%) of the intercounty playing group were
found to be aware of the screening in comparison to 81
(18%) of the non-intercounty group. Increased awareness
among players with intercounty experience was found to be
statistically significant (p-value < 0.001) when compared
to those with no intercounty experience.
Similarly, players with intercounty experience were more
likely to have completed the cardiac screening form than
those with no intercounty experience. A total of 52 (12%)
of the intercounty players had completed screening in comparison to 10 (2%) of the non-intercounty group
(vi) Awareness and completion by province
As is seen in Figure 2, both awareness of cardiac screening
and completion was found to statistically significant (p-value
< 0.001 and p-value < 0.014 respectively) based on which
province a player came from. Also, it is evident that Ulster
faired best in both awareness and uptake levels.
Discussion
Our study’s main aim was to assess the awareness and
uptake level of The GAA Cardiac Screening Programme
amongst the male adult playing population. To our knowledge, no such study has been carried out in the literature
to date. As mentioned above, the estimated total size of
this population is 500,000. Our study cohort comprising of
880 players consisted of 432 (49%) who had intercounty
experience of at least minor level and 448 (51%) who had
no intercounty experience. This was thought to be largely
representative of the overall population group.
The geographical origin of the cohort group was diverse
and all four provinces were represented along with a group
of players from London GAA clubs. A total of 24 counties
were represented in the cohort, thus making generalisability
of our study findings more applicable.
The overall awareness level of the availability of screening was quite low. Only 258 (29%) of the group questioned
were aware of its existence, with only 62 (7%) reporting
completion of the programme. This represented a drop-off
rate of 76%.
These figures are of concern to the GAA. As previously
mentioned, the GAA Cardiac Screening programme was
launched in 2006 with the recommendation that all participants over the age of 14 complete the screening process.
As shown in our study, there is little awareness of the existence of the programme. Perhaps more concerning is that
only a small number of those who were aware subsequently
underwent screening. The reasons for these poor awareness levels and subsequent large fall-off to completion are
unclear and warrant further study.
The data was sub-analysed under the heading of intercounty experience. This highlighted a statistically significant
difference between those with intercounty experience and
those without. A total of 177 (41%) of the intercounty
playing group were found to be aware of screening, in comparison to 81 (18%) of the non-intercounty group. When we
analysed the groups in terms of completion of the screening
programme we found that 52 (12%) of intercounty players
had done so in comparison to only 10 (2%) of the nonintercounty group.
Thus, an intercounty player was six times more likely to
have completed the cardiac screening process compared
to the non-intercounty player. This considerable difference
between the groups may well be due to the emphasis that
has been placed on focusing the efforts of screening on
senior intercounty teams thus far.
As already mentioned, in 2006, The SCD Taskforce recommended that all competitive athletes undergo cardiac
screening to evaluate participation fitness. Initial efforts
have focused on screening senior intercounty GAA players for SADS. A number of counties have followed through
with this recommendation. This approach seems like a
logical start-point, given that the evidence shows that the
incidence of SCD increases with intensity of exercise and
increased level of competition.
However, many club teams are now training and playing at intensity levels similar to that of intercounty teams.
Thus, perhaps the strategy for prioritising screening for
intercounty players is outdated.
Differences in awareness and uptake levels of screening
were also noted when data was analysed under the heading
of province. Statistically significant increased awareness
and uptake was observed in the Ulster province. A number
of factors may be contributing to this situation. As mentioned above, the recent death of a number of high-profile
athletes has lead to increased public awareness of SCD and
calls for national screening. A significant number of these
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players have been from the Ulster province. Coupled with
this, a number of charity-funded cardiac screening facilities
have been set up in Ulster since 2007. These centres are
located in Derry city and the campus of he University of
Ulster Jordanstown and are largely funded by CRY (Cardiac
Risk in the Young). Apart from Tallaght Hospital in Dublin,
screening around the rest of the country is generally provided on a private basis.
Our study analysed the source of player awareness and
found that media (39%) was the main source for informing
players with a player’s club accounting for 32% and medical doctor only 7%. GAA clubs and medical doctors need to
be more pro-active in their approach to screening and make
players more aware of its availability.
Limitations:
Our study surveyed players from 24 counties including
clubs from London. However, nine counties were not surveyed in the study as no club from these counties played
in the tournament on the days of research. However, all
four provinces were well represented. In addition, the total
population of 880 who participated represented the entire
playing population of both blitz tournaments.
Conclusion
The GAA recommends that all playing members undergo
cardiac screening from the age of 14. This recommendation
is based on scientific evidence which has proven that the
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screening tool being used can reduce incidence of SADS
by 89%.1
Our study indicates that awareness of the existence of
the programme and subsequent uptake is extremely low
amongst GAA playing members. In order for any screening
programme to be effective in reducing mortality, it relies
firstly on a significant proportion of the population participating. This requires initial promotion of the availability
of the programme and also developing strategies which
encourage maximum uptake amongst players.
Perhaps funding and availability of medical expertise are
obstacles to be overcome. In any case, the GAA needs to
identify strategies to improve player awareness and uptake
of the programme in order for it be effective in saving the
lives of young GAA athletes.
Authors: John Crowley, GP trainee, South West Specialist
Training Programme; Joe Jordan, SHO, HSE South;
Brendan Crowley, GP; Charlotte Murphy, SHO, HSE South;
Fionnuala Quigley, GP, Department of Exercise and Sports
Medicine, UCC; and Prof Christopher Thompson, consultant
endocrinologist, Beaumont Hospital
Reference
1. Corrado D, Basso C, Schiavon M, Thiene G. Trends in sudden cardiovascular death in young competitive athletes after implementation of a
preparticipation screening program. JAMA. 2006;296:1593-1601
Irish College of General Practitioners
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