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Characteristics and Outcome of Sudden Cardiac Arrest During Sports in Women
Study Questions:
What are the characteristics and outcomes of sudden cardiac death (SCD) during sport activities among women in the general population?
Methods:
A prospective 5-year survey, conducted between April 2005 and April 2010, was designed to be an inclusive national registry of episodes of SCD during sporting events, including recreational as well as competitive sports. The registry included 60 French administrative districts that were comprised of approximately 35 million inhabitants. Among people ages 10-75 years who suffered SCD (resuscitated or not) during competitive or recreational sport activities, 43 (5.2%) of 820 events occurred in women.
Results:
Principal activities at the time of SCD in women were jogging, cycling, and swimming. The level of activity at the time of SCD was moderate to vigorous in 35 cases (81.4%). The overall incidence of sport-related SCD among women ages 15-75 years was estimated as 0.59 (95% confidence interval [CI], 0.39 -0.79) to 2.17 (95% CI, 1.38-2.96) per year per million female sports participants for the 80th and 20th percentiles of reporting districts, respectively. Compared to men, the incidence of SCD in women was dramatically lower, particularly in the 45-54 year age range (relative risk, 0.033; 95% CI, 0.015-0.075). Despite very similar circumstances of occurrence, survival of women at hospital admission (46.6%; 95% CI, 31.0-60.0) was significantly higher than for men (30.0%; 95% CI, 26.8-33.2; p = 0.02), although this did not reach statistical significance for hospital discharge. Favorable neurological outcomes were similar (80%). Cause of death appeared less likely to be associated with structural heart disease in women compared to men (58.3% vs. 95.8%, p = 0.0003).
Conclusions:
Sports-related SCD in women participants appears dramatically less common (up to 30-fold less frequent), compared to men. The authors concluded that these results also suggest a higher likelihood of successful resuscitation as well as lower frequency of underlying structural heart disease in women compared to men.
Perspective:
This study suggests that sports-related SCD occurs much less often in women than in men, a finding that supports broad observational studies. Of interest but unknown would be the absolute rates of underlying structural heart disease in athletic women compared to athletic men; this would allow determination of whether a higher rate of SCD among athletic men is directly attributable to a higher rate of underlying cardiac disease, or whether female sex is an independent protective factor.
Keywords: Cause of Death, Incidence, Risk, Resuscitation, Cardiology, Recreation, Sports, Heart Arrest, Hospitalization, Jogging, Swimming
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