Sudden Cardiac Arrest During Sports Activity | Journal Scan

Study Questions:

What are the incidence, characteristics, and outcomes of sudden cardiac arrest (SCA) during sports activities among middle-aged residents of a large US community?

Methods:

Data were derived from the Oregon Sudden Unexpected Death Study (Oregon-SUDS), an ongoing, prospective community-based study of out-of-hospital SCA in the Portland, Oregon, metropolitan area. Cases of SCA among people aged 35-65 years between 2002 and 2013 were identified using multiple sources including Emergency Medical Services (EMS) response, the Medical Examiner’s office, and emergency departments of all 16 local hospitals; a comprehensive evaluation was performed for each case of unexpected death, including analysis of the circumstances of arrest recorded by EMS personnel or the medical examiner, prearrest medical records, and available autopsy data.

Results:

Of the 1,247 cases of SCA, 63 (5%) occurred during sports activities at a mean age of 51.1 ± 8.8 years, yielding an incidence of 21.7 (95% confidence interval [CI], 8.1-35.4) per million per year. The incidence varied significantly based on sex, with a higher incidence among men (relative risk [RR], 18.68; 95% CI, 2.50-139.56) for sports SCA, compared to all other SCA (RR, 2.58; 95% CI, 2.12-3.13). Sports SCA was more likely to be a witnessed event (87 vs. 53%, p < 0.001), with cardiopulmonary resuscitation (44 vs. 25%, p = 0.001) and ventricular fibrillation (84 vs. 51%, p < 0.0001). Survival to hospital discharge was higher for sports-associated SCA (23.2 vs. 13.6%, p = 0.04). Sports SCA cases presented with known pre-existing cardiac disease in 16%, and ≥1 cardiovascular risk factor in 56%; overall, 36% of cases had typical cardiovascular symptoms during the week preceding SCA.

Conclusions:

Sports-associated SCA in middle age represents a relatively small proportion of the overall SCA burden, reinforcing the idea of the high benefit /low risk nature of sports activity.

Perspective:

Data from Europe suggest that the largest burden of sports-associated SCA is among middle-aged participants. Previous surveys of sudden death in the US reveal that underlying coronary artery disease is often responsible. These data suggest that the incidence of SCA among middle-aged athletes is low. As the authors suggest, targeted education among the aging population could maximize both safety and acceptance of sports activities in older athletes.

Clinical Topics: Arrhythmias and Clinical EP, Prevention, Sports and Exercise Cardiology, Atherosclerotic Disease (CAD/PAD), SCD/Ventricular Arrhythmias

Keywords: Athletes, Autopsy, Cardiopulmonary Resuscitation, Coronary Artery Disease, Death, Sudden, Death, Sudden, Cardiac, Emergency Medical Services, Emergency Service, Hospital, Incidence, Medical Records, Middle Aged, Prospective Studies, Risk, Risk Factors, Sports, Secondary Prevention


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