Cardiac Arrest During Long-Distance Running Races

Study Questions:

What are the incidence and outcomes of cardiac arrest associated with marathon and half-marathon races in the United States?


The incidence and outcomes of cardiac arrest associated with marathon and half-marathon races in the United States were assessed from January 1, 2000, to May 31, 2010. The clinical characteristics of the arrests were determined by interviewing survivors and the next of kin of nonsurvivors, reviewing medical records, and analyzing postmortem data.


Of 10.9 million runners, 59 (mean [± standard deviation] age 42 ± 13 years; 51 men) had cardiac arrest (incidence rate 0.54 per 100,000 participants; 95% confidence interval [CI], 0.41-0.70). Cardiovascular disease accounted for the majority of cardiac arrests. The incidence rate was significantly higher during marathons (1.01 per 100,000; 95% CI, 0.72-1.38) than during half-marathons (0.27; 95% CI, 0.17-0.43), and among men (0.90 per 100,000; 95% CI, 0.67-1.18) than among women (0.16; 95% CI, 0.07-0.31). Male marathon runners, the highest-risk group, had an increased incidence of cardiac arrest during the latter half of the study decade (2000-2004, 0.71 per 100,000 [95% CI, 0.31-1.40]; 2005-2010, 2.03 per 100,000 [95% CI, 1.33-2.98]; p = 0.01). Of the 59 cases of cardiac arrest, 42 (71%) were fatal (incidence, 0.39 per 100,000; 95% CI, 0.28-0.52). Among the 31 cases with complete clinical data, initiation of bystander-administered cardiopulmonary resuscitation and an underlying diagnosis other than hypertrophic cardiomyopathy were the strongest predictors of survival.


The authors concluded that marathons and half-marathons are associated with a low overall risk of cardiac arrest and sudden death. Cardiac arrest, most commonly attributable to hypertrophic cardiomyopathy or atherosclerotic coronary disease, occurs primarily among male marathon participants; the incidence rate in this group increased during the past decade.


Disclosures: 1) I run marathons. 2) If I die during a marathon, I am OK with it. As late as the late 1970s, the medical field was still coming to grips with observations that marathon runners are neither immortal nor impervious to acquired cardiovascular disease (Rennie D, Hollenberg NK. Cardiomythology and marathons. N Engl J Med 1979;301:103-4). Even if health advice given to patients (don’t smoke; exercise, control your diabetes) was carefully followed, eventual death remains certain, and some of that will be cardiovascular. This study does an excellent job in demonstrating that cardiovascular death occurs during distance races, but that it is rare. Exercise has dramatic physical and mental benefits. Even if it does not confer immortality, physicians should emphasize the benefits of exercise rather than perseverating on the rare cardiac death that happens to occur during an athletic event.

Clinical Topics: Arrhythmias and Clinical EP, Diabetes and Cardiometabolic Disease, Prevention, Sports and Exercise Cardiology, Implantable Devices, SCD/Ventricular Arrhythmias, Exercise

Keywords: Survivors, Death, Cardiopulmonary Resuscitation, Running, Heart Arrest, United States

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