Swansea footballer died of natural causes after pitch collapse

Mitchell Joseph died in hospital after suffering a cardiac arrest while playing football

A man who lived an "active life" died of natural causes while playing football, an inquest has concluded.

Mitchell Joseph was playing for St Joseph's FC in the Swansea Senior Football League when he suffered a cardiac arrest and collapsed on the pitch on 13 January 2018.

The 33-year-old died a day later at Morriston Hospital.

Mr Joseph had heart surgery in 2017 and his overall care was considered good.

But Aled Gruffydd, assistant coroner, said an appointments mix-up caused a failure in his post-operative care.

Swansea Bay University Health Board said improvements had been made to its appointment system "to reduce the risk of future deaths".

The inquest heard Mr Joseph had been diagnosed with a heart murmur in 2012.

He had heart valve surgery in May 2017, and his post-surgery recovery was described as "remarkable".

Mr Gruffydd said this high standard was clear because Mr Joseph had been able to cycle from Paris to Swansea in August 2017 for charity.

But in November 2017 Mr Joseph had a hospital appointment in which he was told to return in two weeks.

He never received a letter confirming this and therefore did not attend the follow-up appointment and was discharged from the service.

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Mr Gruffydd told the inquest the missed appointment could have been a chance to have a more "in depth" discussion with the doctor about his exercise routine and medication.

He concluded the mix-up in the appointment system was a "failing" but added it was unclear if this would have prevented Mr Joseph's death.

He said "no human culpability added to the cause of death", and Mr Joseph died of natural causes following a cardiac arrest and damage to the brain due to a prolonged lack of oxygen.

The inquest heard Mr Joseph's heart condition was "slow-acting" and he was asymptomatic.

But according to Mr Pankaj Kumar, a consultant cardiothoracic surgeon at Swansea Bay University Health Board who carried out the surgery, symptoms of the disease can come on quickly when they do develop.

He added Mr Joseph "made a pragmatic and sensible decision" to proceed with surgery as opposed to medication options, as the condition "could have worsened over time".

"Ultimately it wasn't the decision to have surgery which ended Mitchell's life," he said.

Mr Joseph was put on a three-month starting dose of warfarin - medication to help prevent blood clots - after his surgery, the inquest was told.

Mr Gruffydd said, while a 12-month prescription of the drug was the "optimum" dose, "all clinical witnesses agree three months was an appropriate timescale" and a "prolonged period may have done more harm than good".

The assistant coroner said Mr Joseph lived an "active life" and "tolerated exercise well", and all clinicians agreed it was safe for Mr Joseph to do aerobic exercise including the charity bike ride after surgery as long as he "didn't over exert".

Mr Gruffydd said he was unable to find a failing in this advice as Mr Joseph "had been unscathed" when he had previously exercised and played football after surgery, but that "getting the balance right between anaerobic and aerobic is hard".

He said it was a "completely unfortunate situation that Mitchell's heart had so many problems" and sent his "deepest condolences" to Mr Joseph's family who attended the inquest.

Swansea Bay University Health Board now sends an email document as well as written confirmation of a follow-up appointment to reception staff, the inquest was told.

Mr Gruffydd said he was "hopeful that this avoids other families having to go through the same pain".