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Sudden Cardiac Arrest During Sports Activity in Older Adults
Quick Takes
- Adults aged ≥65 years who had a sudden cardiac arrest while exercising were more likely to be male, had a lower event rate if they exercised than those who did not exercise, and had fewer comorbidities than those who did not exercise. Survival was fourfold higher if they were exercising at the time of sudden cardiac arrest.
- Sudden cardiac arrest was more frequent while cycling, gym activity, or running.
- Witnessed cardiac arrest with bystander CPR, presence of a shockable rhythm, and early defibrillation were the most common factors that resulted in hospital discharge.
Study Questions:
What are the prevalence and characteristics of sudden cardiac arrest in adults aged ≥65 years who had an event during exercise?
Methods:
A prospective chart review was conducted between 2002 and 2021 (Oregon 2002–2017 and Ventura 2015–2021) in two northwest communities of all sudden cardiac arrests to determine activity level at time of arrest (exercising vs. not actively exercising), underlying health issues, and warning symptoms. Patients who were ≥65 years old were analyzed to determine type of activity, number of cardiac risk factors, and known presence of heart disease.
Results:
Of 4,078 sudden cardiac arrests among subjects ≥65 years of age, 77 were exercising (1.9%; 91% men). The most common associated activities were cycling, gym activity, and running. Sudden cardiac arrest while exercising cases had lower burden of cardiovascular risk factors (p = 0.03) as well as comorbidities (p < 0.005) compared with the nonexercising sudden cardiac arrest group. Warning signs 24 hours before the arrest included chest pain with activity, not feeling well, dizziness, nausea, and fatigue. Survival rate in the exercise group was 43.8% versus 11.1% in the nonexercising group.
Conclusions:
The risk of sudden cardiac arrest was low in the exercise group. The authors concluded that the benefits of exercise outweighed the risks of a sudden cardiac event.
Perspective:
Sudden cardiac arrest during exercise does occur in the older population. Having access to bystander cardiopulmonary resuscitation (CPR) and defibrillation has been shown to improve survival. Advocating for bystander CPR training with access to AEDs in places where exercise is occurring can improve outcomes for all ages. Patients should be encouraged to exercise even if they are older and have a history of coronary artery disease. Patients should be educated on the warning signs of progressive coronary artery disease and be advised to not exercise if they have symptoms.
Clinical Topics: Arrhythmias and Clinical EP, Diabetes and Cardiometabolic Disease, Geriatric Cardiology, Prevention, Sports and Exercise Cardiology, Atherosclerotic Disease (CAD/PAD), Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Exercise
Keywords: Arrhythmias, Cardiac, Cardiopulmonary Resuscitation, Chest Pain, Coronary Artery Disease, Death, Sudden, Cardiac, Defibrillators, Dizziness, Exercise, Geriatrics, Heart Arrest, Nausea, Patient Care Team, Patient Discharge, Risk Factors, Running, Secondary Prevention, Sports, Survival Rate
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