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Incidence of Cardiac Arrest During Sports Among Women
Quick Takes
- Sudden cardiac arrest during sports (Sr-SCA) appears to be extremely rare among women participants compared to men, with similar characteristics, circumstances of occurrence, and survival, reaching up to 60% at hospital discharge.
- Of note, there is no singular physiopathological explanation for this very low risk of Sr-SCA in women.
- These data should be factored in designing preparticipation screening strategies for women athletes in the future.
Study Questions:
What are the incidence, characteristics, and outcomes of women presenting with sudden cardiac arrest during sports (Sr-SCA)?
Methods:
The investigators analyzed data from three population-based European registries (ESCAPE-NET 2020 Horizon Program), which prospectively and exhaustively collect every case of SCA: SDEC (Paris-Sudden Death Expertise Center), ARREST (AmsteRdam REsuscitation Studies), and SRCR (Swedish Register for Cardiopulmonary Resuscitation). Sr-SCA was defined as SCA during or ≤1 hour after cessation of sports activity. The authors calculated the weighted average incidence rate of Sr-SCA across the three registries stratified by sex and age group (18-39, 40-64, 65-75, 75+ years), including a fixed effect on the country (to account for variability of the registries). Multivariable logistic regression analysis was also performed to assess correlates of survival at hospital discharge.
Results:
Out of 34,826 SCAs between 2006 and 2017, 760 Sr-SCAs (2.2%) were identified, including 54 in women. The average annual incidence of Sr-SCA in women in the three registries ranged from 0.10 (95% confidence interval [CI], 0.01-0.71) to 0.38 (95% CI, 0.14-1.04) per million. Overall, the average annual incidence rate of Sr-SCA in women was 0.19 (95% CI, 0.14-0.24) per million; >10-fold lower compared to men (2.63 [95% CI, 2.45-2.83] per million, p < 0.0001). When extrapolating to the total European population and accounting for age/sex, this yields 98 cases per year (95% CI, 72-123) in women and 1,350 in men (95% CI, 1,256-1,451). Subject characteristics and circumstances of occurrence were similar in women versus men. Bystander response, time to defibrillation, and survival rate at hospital admission (58.8 vs. 58.5%, p = 0.99) and 30 days did not differ significantly between women and men.
Conclusions:
The authors report that these findings emphasize the dramatically lower risk of Sr-SCA in women compared with men, despite similar subject characteristics.
Perspective:
This large population-based multi-nation study demonstrates that Sr-SCA appears to be extremely rare among women participants (up to 13-fold lower compared to men), with similar characteristics, circumstances of occurrence, and survival, reaching up to 60% at hospital discharge with early bystander cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) use. Of note, there is no singular physiopathological explanation for this very low risk of Sr-SCA in women. These data should be factored in designing preparticipation screening strategies for women athletes in the future, given also the very high rate of survival among those who benefit from both bystander CPR and public AED use.
Clinical Topics: Arrhythmias and Clinical EP, Prevention, Sports and Exercise Cardiology, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias
Keywords: Arrhythmias, Cardiac, Athletes, Cardiopulmonary Resuscitation, Death, Sudden, Cardiac, Defibrillators, Heart Arrest, Incidence, Patient Discharge, Secondary Prevention, Sports, Survival Rate, Women
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