Sudden Cardiac Arrest during Participation in Competitive Sports

Abstract

Background: The incidence of sudden cardiac arrest during participation in sports activities remains unknown. Preparticipation screening programs aimed at preventing sudden cardiac arrest during sports activities are thought to be able to identify at-risk athletes; however, the efficacy of these programs remains controversial. We sought to identify all sudden cardiac arrests that occurred during participation in sports activities within a specific region of Canada and to determine their causes.

Methods: In this retrospective study, we used the Rescu Epistry cardiac arrest database (which contains records of every cardiac arrest attended by paramedics in the network region) to identify all out-of-hospital cardiac arrests that occurred from 2009 through 2014 in persons 12 to 45 years of age during participation in a sport. Cases were adjudicated as sudden cardiac arrest (i.e., having a cardiac cause) or as an event resulting from a noncardiac cause, on the basis of records from multiple sources, including ambulance call reports, autopsy reports, in-hospital data, and records of direct interviews with patients or family members.

Results: Over the course of 18.5 million person-years of observation, 74 sudden cardiac arrests occurred during participation in a sport; of these, 16 occurred during competitive sports and 58 occurred during noncompetitive sports. The incidence of sudden cardiac arrest during competitive sports was 0.76 cases per 100,000 athlete-years, with 43.8% of the athletes surviving until they were discharged from the hospital. Among the competitive athletes, two deaths were attributed to hypertrophic cardiomyopathy and none to arrhythmogenic right ventricular cardiomyopathy. Three cases of sudden cardiac arrest that occurred during participation in competitive sports were determined to have been potentially identifiable if the athletes had undergone preparticipation screening.

Conclusions: In our study involving persons who had out-of-hospital cardiac arrest, the incidence of sudden cardiac arrest during participation in competitive sports was 0.76 cases per 100,000 athlete-years. The occurrence of sudden cardiac arrest due to structural heart disease was uncommon during participation in competitive sports. (Funded by the National Heart, Lung, and Blood Institute and others.).

Figure 1. Identification and Classification of Out-of-Hospital Sudden Cardiac Arrest during Sports in Persons 12 to 45 Years of Age

All 3825 out-of-hospital cardiac arrests that occurred among persons 12 to 45 years of age from 2009 through 2014 and were reported in the Rescu Epistry database were filtered on the basis of the type of location (e.g., a recreational facility) of the cardiac arrest. All 2144 remaining cases were then manually filtered for out-of-hospital cardiac arrests that occurred during or within 1 hour after a sports activity. This remaining cohort of 74 cases was assessed comprehensively with the use of all available records to adjudicate the cause of sudden cardiac arrest; cases of cardiac arrest due to noncardiac causes (e.g., hanging, trauma, mechanical suffocation, asphyxia from drowning, or toxic inhalation) were excluded from the assessment. EMS denotes emergency medical services.