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In his latest blog - Mortality due to heart-related problems among professional footballers -, FIFPro Chief Medical Officer Dr. Vincent Gouttebarge PhD explains FIFPro's concerns about the Pre-Competition Medical Assessment in professional football. 

Dr. Gouttebarge also makes recommendations on how to improve the current situation for the benefit of all professional footballers.



Key points

  • Of all tragic events (sudden death) occurring in young athletes (all sport disciplines) aged from 12 to 35 years old, the majority (over 90 %) are due to heart-related causes (sudden cardiac death).
  • Of all deaths recorded during an international FIFPro study over the past 7 years, more than 25 % were ascribed to suspected cardiac pathology that was related directly to football participation and in more than 50 % of the cases for current players.
  • To prevent sudden cardiac death, governing football bodies (FIFA, UEFA, AFC etc.) have made a heart-related pre-competition medical assessment mandatory for top international and continental competitions but these are only recommended to other leagues.
  • FIFPro advocates the implementation and application of a heart-related pre-competition medical assessment for all players across continents and countries, medical assessment being standardised conforming to the latest scientific evidence.


In recent decades, professional football has attracted growing interest, becoming the most popular professional sport in the world. Consequently, the life of professional footballers, both on and off the playing area, has been exponentially scrutinised on all social media, newspapers and television channels, both during and after football retirement. Next to the many appreciative records related to football performances, rather negative events occurring among professional footballers have been also reported for years, even more the catastrophic events related to heart-related conditions.

Heart-related deaths in sports

Research shows that the most common cause of deaths in athletes is heart-related, referred to as sudden cardiac death (SCD). A study of occurrences of tragic events (sudden death) in young athletes (participating in an organised sports programme requiring regular training and competition) aged from 12 to 35 years old, indicated that over 90 % of the deaths are due to SCD (Corrado 2003; Bille 2006; Maron 2009). A recent study among college and high school American football players pointed out that the most common cause for the 243 deaths between 1990 and 2010 was SCD (41.2 %) (Boden 2013). Although reported in almost all sport disciplines, several authors stated that SCD occurs most frequently (30 %) in football (soccer) (Corrado 2003; Maron 2009).

The first study mentioned also concluded that sudden death in young athletes aged from 12 to 35 years old has been estimated at 6 to 36 deaths per 10,000 athletes per year, which is 2.8 times higher than in non-athletes (not participating in an organised sports programme) (Corrado 2003; Maron 2009; Borjesson 2011).

Heart-related deaths in professional football

Descriptive scientific studies about heart-related tragic events in professional football have been lacking. Consequently, the World Footballers' Association FIFPro – the voice of more than 65,000 professional footballers worldwide, has since 2007 been conducting an observational prospective study in order to monitor the occurrence of events with tragic outcomes in professional footballers (either active or recently retired). From all recorded deaths over the past 8 years, more than 25 % were ascribed to suspected cardiac pathology related to direct football participation and in more than 50 % of the cases for current players (Gouttebarge 2014). The findings of this FIFPro study are in line with the study of Belli and Vanacore (2007). Over the study period of 37 years, the authors found that the primary cause for the 350 deaths observed was diseases, of which 22 % were heart-related (Belli 2007).

In order to prevent heart-related deaths (SCD) among professional footballers, international, continental and national governing authorities have implemented a cardiovascular pre-competition medical assessment.

Pre-competition medical assessment in sports

In order to prevent SCD in sports, heart-related pre-competition medical assessment (PCMA) based on the Lausanne Recommendations has been implemented for nearly a decade (Corrado 2005). The Lausanne protocol relies on anamnesis (self-reported medical history), physical examination, blood analysis and rest-electrocardiogram (ECG) (Corrado 2005; Bille 2006). For many years, PCMA following the Lausanne protocol has been widely used by many (inter)national sports organisations. However, the validity of this cardiovascular screening protocol has also been repeatedly questioned, especially the predictive value of the rest-ECG (Dutch Health Council 2006; Inklaar 2007; Elston 2009; La Gerche 2010). Consequently, more extensive cardiovascular examinations by means of echocardiography and/or stress-ECG have been added for professional i.e. elite athletes, echocardiography being of unchallenged value in the diagnosis of cardiac risk (Thunenkotter 2010).

The Pre-Competition Medical Assessment in professional football

Nearly a decade ago, FIFA introduced for all international competitions (men, women, youth) a mandatory PCMA in order to detect risk factors challenging players' health with regard to injuries and SCD (among others). The heart-related part of the FIFA pre-competition medical assessment (PCMA) relies strongly on the Lausanne protocol, replacing the rest-ECG by a stress-ECG and adding echocardiography (Dvorak 2009). In continental competitions, football authorities have implemented a similar heart-related PCMA that has to be completed before the start of the competition and that has to be renewed annually. In Europe, this PCMA is mandatory for several competitions such as UEFA Champions League or Europa League as well as for European championships (men, women and youth), but is only recommended for other national competitions.

Why football authorities such as FIFA and UEFA make any differentiation between professional players within the same team or competition when it comes to the status and quality of their heart-related PCMA remains unknown, and seems hard to justify.

Main FIFPro concerns and recommendations

FIFPro – the voice of more than 65,000 professional footballers worldwide – emphasises that professional footballers, being workers i.e. employees in the eyes of the law, should have the same rights from one employer to another for any matters, especially with regard to health and safety. Consequently, the governing bodies within professional football (FIFA, UEFA, AFC...) should not only consider the necessity of heart-related PCMA for players participating in highest international or continental competitions but for all professional players participating to any professional national competitions, regardless of continent or country.

As a result of the aforementioned, FIFPro, which stands for the equality of all professional footballers worldwide, would like to address the following recommendations:

  • The heart-related PCMA protocol in professional football across continents and countries should be standardised conforming to the latest scientific evidence. As FIFPro advocates the equality of all professional footballers across continents and countries, it is hard to explain to our players – all employees from the same occupational category – why they could be assessed differently within the same club (international players vs. non-international players) or from one club (employer) to another.
  • The PCMA should be made mandatory at all professional levels by the (inter)national governing bodies regardless of continent or country. In addition, cardiac evaluation based on detailed personal and family history and on thorough physical examination should be made mandatory for all youth players from any professional football club academy, starting from an age of 12-14 years old.
  • The mandatory character of the PCMA for all professional footballers (including youth) previously advocated should be guaranteed. Therefore, evaluation committees should visit worksites in order to control and monitor the application and quality of preventive cardiac evaluation in professional clubs. A potential sanction system should be developed and implemented by the governing bodies within professional football (FIFA, UEFA, AFC, etc.) if a professional club jeopardises the health and safety of its employees i.e. professional footballers. 


Dr. Vincent Gouttebarge PhD and former professional footballer
Chief Medical Officer World Footballers' Union FIFPro
+31 621547499