F-MARC: the FIFA Sudden Death Registry (FIFA-SDR)

INTRODUCTION Death of an athlete during sports is tragic, and sudden cardiac death (SCD) is the most common cause. It is estimated, that the incidence of a SCD in athletes varies between 1:917 000 and 1:3000, whereas studies with higher methodological quality consistently report ranges between 1:40 000 to 1:80 000. In addition, it has been stated that subgroups and sport disciplines may be at a higher risk for SCD, such as males, AfricanAmericans, Africans/Americans, basketball, football and tennis. As football is the most popular sport in the world, with more than about 250 million active players registered, a relevant number of professional and recreational football players may have unknown cardiovascular diseases and therefore, be at risk for SCD. In an own nationwide registry on SCD in sports (Sudden Cardiac Death Germany; http://www.scd-deutschland.de), due to the high popularity of football and therefore, the high number of active and recreational football players in Germany, football was the most commonly affected sport discipline with 20 of the 73 cases (27%) registered as SCD. Driven by the tragic SCD of the professional football player Marc Vivien Foe on the pitch during the FIFA Confederations Cup 2003, FIFA implemented a standardised ‘precompetition medical assessment’ (PCMA) in 2006 to detect cardiovascular pathologies and prevent SCD or sudden cardiac arrests (SCA; survived or successfully resuscitated cardiac death) in football players. Nevertheless, the optimisation of preventive sports medical screening programmes depends on the knowledge about the underlying diseases leading to sudden deaths as well as their regional, age and gender distribution, as the cardiovascular pathologies of SCD/SCA seem to differ between ethnicities with, for example, a higher proportion of hypertrophic cardiomyopathy in the USA versus a higher proportion of arrhythmogenic right ventricular cardiomyopathy in the Veneto region of Italy, Spain and Denmark, or myocardial infarction as the leading cause in other European countries. In a recent review, the percentage of football-related deaths among total sportsInstitute for Sports and Preventive Medicine, Saarland University, Saarbrücken, Germany; FIFA Medical Assessment and Research Centre (F-MARC), Zurich, Switzerland