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Introduction Elite sporting organisations in the Western world advocate cardiac screening to mitigate sudden cardiac death (SCD) risks. Data relating to the diagnostic yield of such programmes in sport are dominated by male athletes. A previous study of >11,000 football players, predominantly male, reported a 0.38% prevalence of cardiac disorders linked to SCD, a 2% prevalence of minor cardiac disorders, and 0.9% of participants presenting with concerning symptoms. The aim of this study was to investigate the prevalence of cardiac disease and subsequent outcomes amongst screened female football players in the UK. We also report ECG and echocardiogram characteristics in this previously underreported population.Methods From 2000 to 2024, 3,121 female football players underwent cardiac screening as part of the English Football Association (FA) programme, which comprised a health questionnaire, physical examination, 12-lead ECG, and transthoracic echocardiogram. The FA registry was reviewed for cardiac morbidity and SCD over a 6.1-year follow-up period. ECG and echocardiogram characteristics were compared to an age- and ethnicity-matched cohort of 3,000 male football players.Results Female athletes had a mean age of 19.8±5.4 years and 2,716 (87%) were white. 284 (9.1%) athletes reported ≥1 cardiac symptom, and 165 (5.3%) required additional investigations. Six (0.2%) athletes were identified with significant cardiac disorders associated with SCD, and 33 (1.1%) had minor cardiac conditions. Over a follow-up of 6.1±4.7 years (16,507 cumulative person-years), there were no cases of SCD, and one (0.03%) case of non-ischaemic cardiomyopathy diagnosed post-screening.Compared with age- and ethnicity-matched male football players, females had a lower prevalence of sinus bradycardia (39.1% vs 45.2%; p<0.0001), sinus arrhythmia (15.0% vs 38.5%; p<0.0001), LV hypertrophy (8.7% vs 24.8%; p<0.0001), and RV hypertrophy (0.4% vs 2.3%; p<0.0001), but a longer PR interval (150±24 vs 140±14ms; p<0.0001) and QTc interval (417±26 vs 398±16ms; p<0.0001). T-wave inversion was more common in females (13.4% vs 2.8%; p<0.0001), with a distribution of 12.2% in anterior leads, 1.1% in inferior leads, and 0.2% in lateral leads. Echocardiography revealed smaller left (47.3±3.7 vs 51.1±4.3mm; p<0.0001) and right (34.0±5.2 vs 37.7±4.7mm; p<0.0001) ventricular diameters in females compared to males.Abstract 7-040 Table 1Electrocardiographic characteristics of female football players compared to a male cohortFemale football players(n= 3,121) Male football players(n=3,000) P value Sinus bradycardia <60 bpm1,220 (39.1%)1,356 (45.2%)<0.0001Sinus arrhythmia468 (15.0%)1,155 (38.5%)<0.0001LV hypertrophy273 (8.7%)744 (24.8%)<0.0001RV hypertrophy12 (0.4%)69 (2.3%)<0.0001Mean QTc interval, ms417±26398±16<0.0001T-wave inversion, all418 (13.4%)84 (2.8%)<0.0001T-wave inversion, anterior beyond V281 (2.6%)24 (0.8%)<0.0001T-wave inversion, inferior leads34 (1.1%)18 (0.6%)0.052T-wave inversion, lateral leads6 (0.2%)9 (0.3%)0.553Abstract 7-040 Table 2Echocardiographic characteristics of female football players compared to a male cohortFemale football players(n= 3,121) Male football players(n=3,000) P value LV end-diastolic diameter, mm47.3±3.751.1±4.3<0.0001Indexed LV end-diastolic diameter, mm/m227.8±2.4026.9±2.56<0.0001Maximal LV wall thickness, mm8.00±1.19.18±1.2<0.0001Relative wall thickness LV, mm 0.34±0.050.36±0.08<0.0001LV mass, g123±26169±35<0.0001Indexed LV mass, g/m271.8±14.288.6±16.9<0.0001Basal RV diameter (D1), mm34.0±5.237.7±4.7<0.0001Indexed basal RV diameter, D1/m220.0±3.0419.8±2.60<0.01Aortic root (Sinus of Valsalva) diameter, mm25.2±3.428.1±3.5<0.0001Abstract 7-040 Figure 1Outcomes of cardiovascular screening in female football playersSCD, sudden cardiac death; WPW, Wolff-Parkinson-WhiteConclusion Despite more frequent cardiac symptoms in female athletes, the prevalence of life-threatening conditions was lower compared to males. Female football players demonstrated electrical diseases most commonly at screening with one case of cardiomyopathy and no cases of SCD recorded during the six-year follow-up.