Skip to main content
Search
Search
Quick Search anywhere
Quick Search in Journals
Quick Search in Journals
Quick Search in Journals
Quick Search in Journals
Quick Search in Journals
Quick Search in Journals
Quick Search in Journals
Quick Search in Journals
Quick Search in Journals
Quick Search in Journals
Skip main navigationClose Drawer MenuOpen Drawer Menu
JACC Journals › JACC › Archives › Vol. 79 No. 3
Previous
Next

Evolution of Incidence, Management, and Outcomes Over Time in Sports-Related Sudden Cardiac Arrest

Original Investigation

J Am Coll Cardiol. 2022 Jan, 79 (3) 238–246
Topic(s):
Editorial Comment: Sudden Cardiac Arrest in Sport: Reactive Success Versus Proactive Failure?∗
Sections

Central Illustration

Abstract

Background

Major efforts have been made to reduce the burden of sports-related sudden cardiac arrest (SrSCA). The extent to which the incidence, management, and outcomes changed over time has not been investigated.

Objectives

The purpose of this study was to assess temporal trends in SrSCA incidence, management, and survival.

Methods

Using data from the French National Institute of Health and Medical Research, we evaluated the evolution of incidence, prehospital management, and survival at hospital discharge of SrSCA among subjects aged 18 to 75 years, over 6 successive 2-year periods between 2005 and 2018.

Results

Among the 377 SrSCA, 20 occurred in young competitive athletes (5.3%), whereas 94.7% occurred in middle-aged recreational sports participants. Comparing the last 2-year to the first 2-year period, SrSCA incidence remained stable (6.24 vs 7.00 per million inhabitants/y; P = 0.51), with no significant differences in patients' mean age (46.6 ± 13.8 years vs 51.0 ± 16.4 years; P = 0.42), sex (men 94.7% vs 95.2%; P = 0.99), and history of heart disease (12.5% vs 15.9%; P = 0.85). However, frequency of bystander cardiopulmonary resuscitation and public automated external defibrillator use increased significantly (34.9% vs 94.7%; P < 0.001 and 1.6% vs 28.8%; P = 0.006, respectively). Survival to hospital discharge improved steadily, reaching 66.7% in the last study period compared with 23.8% in the first (P < 0.001).

Conclusions

Incidence of SrSCA remained relatively stable over time, suggesting a need for improvement in screening strategies. However, major improvements in on-field resuscitation led to a 3-fold increase in survival, underlining the value of public education in basic life support that should serve as an example for SCA in general.

  • 1. Benjamin E.J., Virani S.S., Callaway C.W., et al. "Heart disease and stroke statistics-2018 update: a report from the American Heart Association". Circulation 2018;137:e67-e492.

    CrossrefMedlineGoogle Scholar

  • 2. Deo R., Albert C.M. "Epidemiology and genetics of sudden cardiac death". Circulation 2012;125:620-637.

    CrossrefMedlineGoogle Scholar

  • 3. Landry C.H., Allan K.S., Connelly K.A., et al. "Sudden cardiac arrest during participation in competitive sports". N Engl J Med 2017;377:1943-1953.

    CrossrefMedlineGoogle Scholar

  • 4. Maron B.J., Friedman R.A., Kligfield P., et al. "Assessment of the 12-lead electrocardiogram as a screening test for detection of cardiovascular disease in healthy general populations of young people (12-25 years of age): a scientific statement from the American Heart Association and the American College of Cardiology". J Am Coll Cardiol 2014;64:1479-1514.

    View ArticleGoogle Scholar

  • 5. Mont L., Pelliccia A., Sharma S., et al. "Pre-participation cardiovascular evaluation for athletic participants to prevent sudden death: paper from the EHRA and the EACPR, branches of the ESC. Endorsed by APHRS, HRS, and SOLAECE". Eur J Prev Cardiol 2017;24:41-69.

    CrossrefMedlineGoogle Scholar

  • 6. Corrado D., Basso C., Pavei A., Michieli P., Schiavon M., Thiene G. "Trends in sudden cardiovascular death in young competitive athletes after implementation of a preparticipation screening program". JAMA 2006;296:1593-1601.

    CrossrefMedlineGoogle Scholar

  • 7. Hallstrom A.P., Ornato J.P., Weisfeldt M., et al. "Public-access defibrillation and survival after out-of-hospital cardiac arrest". N Engl J Med 2004;351:637-646.

    CrossrefMedlineGoogle Scholar

  • 8. Hasselqvist-Ax I., Riva G., Herlitz J., et al. "Early cardiopulmonary resuscitation in out-of-hospital cardiac arrest". N Engl J Med 2015;372:2307-2315.

    CrossrefMedlineGoogle Scholar

  • 9. Kitamura T., Kiyohara K., Sakai T., et al. "Public-access defibrillation and out-of-hospital cardiac arrest in Japan". N Engl J Med 2016;375:1649-1659.

    CrossrefMedlineGoogle Scholar

  • 10. Jacobs I., Nadkarni V., Bahr J., et al. "Cardiac arrest and cardiopulmonary resuscitation outcome reports: update and simplification of the Utstein templates for resuscitation registries: a statement for healthcare professionals from a Task Force of the International Liaison Committee on Resuscitation (American Heart Association, European Resuscitation Council, Australian Resuscitation Council, New Zealand Resuscitation Council, Heart and Stroke Foundation of Canada, InterAmerican Heart Foundation, Resuscitation Councils of Southern Africa)". Circulation 2004;110:3385-3397.

    CrossrefMedlineGoogle Scholar

  • 11. Marijon E., Tafflet M., Celermajer D.S., et al. "Sports-related sudden death in the general population". Circulation 2011;124:672-681.

    CrossrefMedlineGoogle Scholar

  • 12. Bougouin W., Lamhaut L., Marijon E.et al.for the SDEC Co-Investigators. "Characteristics and prognosis of sudden cardiac death in Greater Paris: population-based approach from the Paris Sudden Death Expertise Center (Paris-SDEC)". Intensive Care Med 2014;40:846-854.

    CrossrefMedlineGoogle Scholar

  • 13. Jabre P., Bougouin W., Dumas F., et al. "Early identification of patients with out-of-hospital cardiac arrest with no chance of survival and consideration for organ donation". Ann Intern Med 2016;165:770-778.

    CrossrefMedlineGoogle Scholar

  • 14. Waldmann V., Bougouin W., Karam N.et al.for the Paris-Sudden Death Expertise Center (Paris-SDEC) Investigators. "Coronary vasospasm-related sudden cardiac arrest in the community". J Am Coll Cardiol 2018;72:814-815.

    View ArticleGoogle Scholar

  • 15. Fishman G.I., Chugh S.S., Dimarco J.P., et al. "Sudden cardiac death prediction and prevention: report from a National Heart, Lung, and Blood Institute and Heart Rhythm Society Workshop". Circulation 2010;122:2335-2348.

    CrossrefMedlineGoogle Scholar

  • 16. Marijon E., Uy-Evanado A., Reinier K., et al. "Sudden cardiac arrest during sports activity in middle age". Circulation 2015;131:1384-1391.

    CrossrefMedlineGoogle Scholar

  • 17. Maron B.J., Haas T.S., Murphy C.J., Ahluwalia A., Rutten-Ramos S. "Incidence and causes of sudden death in U.S. college athletes". J Am Coll Cardiol 2014;63:1636-1643.

    View ArticleGoogle Scholar

  • 18. Harmon K.G., Asif I.M., Maleszewski J.J., et al. "Incidence and etiology of sudden cardiac arrest and death in high school athletes in the United States". Mayo Clin Proc 2016;91:1493-1502.

    CrossrefMedlineGoogle Scholar

  • 19. "Loi n° 99-223 du 23 mars 1999 relative à la protection de la santé des sportifs et à la lutte contre le dopage. Titre Ier: De La Surveillance Médicale Des Sportifs (Articles 5 à 13). Legifrance". Accessed October 24, 2021. https://www.legifrance.gouv.fr/affichTexteArticle.do?idArticle=LEGIARTI000006696379&cidTexte=LEGITEXT000005627684&dateTexte=19990324.

    Google Scholar

  • 20. "Recommendations concerning the content of the cardiovascular assessment of the visit of no contraindication to the practice of sport in competition between 12 and 35 years – 2009". French Society of Cardiology . Accessed October 24, 2021. https://www.sfcardio.fr/publication/recommandations-concernant-le-contenu-du-bilan-cardiovasculaire-de-la-visite-de-non.

    Google Scholar

  • 21. Borjesson M., Urhausen A., Kouidi E., et al. "Cardiovascular evaluation of middle-aged/ senior individuals engaged in leisure-time sport activities: position stand from the sections of exercise physiology and sports cardiology of the European Association of Cardiovascular Prevention and Rehabilitation". Eur J Cardiovasc Prev Rehabil 2011;18:446-458.

    CrossrefMedlineGoogle Scholar

  • 22. Jennett B., Bond M. "Assessment of outcome after severe brain damage". Lancet 1975;1:480-484.

    CrossrefMedlineGoogle Scholar

  • 23. Vandenbroucke J.P. "The making of STROBE". Epidemiol Camb Mass 2007;18:797-799.

    CrossrefMedlineGoogle Scholar

  • 24. Link M.S., Atkins D.L., Passman R.S., et al. "Part 6: electrical therapies: automated external defibrillators, defibrillation, cardioversion, and pacing: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care". Circulation 2010;122:S706-S719.

    CrossrefMedlineGoogle Scholar

  • 25. Monsieurs K.G., Nolan J.P., Bossaert L.L., et al. "European Resuscitation Council Guidelines for Resuscitation 2015: section 1. Executive summary". Resuscitation 2015;95:1-80.

    CrossrefMedlineGoogle Scholar

  • 26. Chan P.S., Krumholz H.M., Nichol G., Nallamothu B.K. "American Heart Association National Registry of Cardiopulmonary Resuscitation Investigators. Delayed time to defibrillation after in-hospital cardiac arrest". N Engl J Med 2008;358:9-17.

    CrossrefMedlineGoogle Scholar

  • 27. "Décret n° 2007-705 du 4 mai 2007 relatif à l’utilisation des défibrillateurs automatisés externes par des personnes non médecins et modifiant le code de la santé publique (dispositions réglementaires)". 2007. Accessed June 24, 2021. https://www.legifrance.gouv.fr/eli/decret/2007/5/4/SANP0721586D/jo/texte.

    Google Scholar

  • 28. Borjesson M., Serratosa L., Carre F., et al. "Consensus document regarding cardiovascular safety at sports arenas". Eur Heart J 2011;32:2119-2124.

    CrossrefMedlineGoogle Scholar

  • 29. Delhomme C., Njeim M., Varlet E., et al. "Automated external defibrillator use in out-of-hospital cardiac arrest: Current limitations and solutions". Arch Cardiovasc Dis 2019;112:217-222.

    CrossrefMedlineGoogle Scholar

  • 30. Marijon E., Bougouin W., Tafflet M., et al. "Population movement and sudden cardiac arrest location". Circulation 2015;131:1546-1554.

    CrossrefMedlineGoogle Scholar

  • 31. Chan P.S., McNally B., Tang F., Kellermann A., for the CARES Surveillance Group. "Recent trends in survival from out-of-hospital cardiac arrest in the United States". Circulation 2014;130:1876-1882.

    CrossrefMedlineGoogle Scholar

  • 32. Marijon E., Bougouin W., Celermajer D.S., et al. "Major regional disparities in outcomes after sudden cardiac arrest during sports". Eur Heart J 2013;34:3632-3640.

    CrossrefMedlineGoogle Scholar

  • 33. Corrado D., Pelliccia A., Bjørnstad H.H., et al. "Cardiovascular pre-participation screening of young competitive athletes for prevention of sudden death: proposal for a common European protocol. Consensus Statement of the Study Group of Sport Cardiology of the Working Group of Cardiac Rehabilitation and Exercise Physiology and the Working Group of Myocardial and Pericardial Diseases of the European Society of Cardiology". Eur Heart J 2005;26:516-524.

    CrossrefMedlineGoogle Scholar

  • 34. Maron B.J., Thompson P.D., Ackerman M.J., for the American Heart Association Council on Nutrition, Physical Activity, and Metabolism. "Recommendations and considerations related to preparticipation screening for cardiovascular abnormalities in competitive athletes: 2007 update: a scientific statement from the American Heart Association Council on Nutrition, Physical Activity, and Metabolism: endorsed by the American College of Cardiology Foundation". Circulation 2007;115:1643-1655.

    CrossrefMedlineGoogle Scholar

  • 35. Sharma S., Drezner J.A., Baggish A., et al. "International Recommendations for Electrocardiographic Interpretation in Athletes". J Am Coll Cardiol 2017;69:1057-1075.

    View ArticleGoogle Scholar

  • 36. Ljungqvist A., Jenoure P., Engebretsen L., et al. "The International Olympic Committee (IOC) Consensus Statement on periodic health evaluation of elite athletes March 2009". Br J Sports Med 2009;43:631-643.

    CrossrefMedlineGoogle Scholar

  • 37. Malhotra A., Dhutia H., Finocchiaro G., et al. "Outcomes of cardiac screening in adolescent soccer players". N Engl J Med 2018;379:524-534.

    CrossrefMedlineGoogle Scholar

  • 38. "Les chiffres clés du sport 2017". Accessed October 24, 2021. http://www.sports.gouv.fr/accueil-du-site/a-la-une/article/Les-chiffres-cles-du-sport-2017.

    Google Scholar

  • 39. Piepoli M.F., Hoes A.W., Agewall S., for the ESC Scientific Document Group. "2016 European guidelines on cardiovascular disease prevention in clinical practice: The Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of 10 societies and by invited experts)". Eur Heart J 2016;37:2315-2381.

    CrossrefMedlineGoogle Scholar

  • 40. Knuuti J., Wijns W., Saraste A.et al.for the ESC Scientific Document Group. "2019 ESC guidelines for the diagnosis and management of chronic coronary syndromes". Eur Heart J 2020;41:407-477.

    CrossrefMedlineGoogle Scholar

  • 41. Marijon E., Uy-Evanado A., Dumas F., et al. "Warning symptoms are associated with survival from sudden cardiac arrest". Ann Intern Med 2016;164:23-29.

    CrossrefMedlineGoogle Scholar

  • 42. Müller D., Agrawal R., Arntz H.-R. "How sudden is sudden cardiac death?"Circulation 2006;114:1146-1150.

    CrossrefMedlineGoogle Scholar

  • 43. Lynge T.H., Risgaard B., Jabbari R., et al. "Cardiac symptoms before sudden cardiac death caused by hypertrophic cardiomyopathy: a nationwide study among the young in Denmark". Europace 2016;18:1801-1808.

    MedlineGoogle Scholar

  • 44. Narayan S.M., Wang P.J., Daubert J.P. "New concepts in sudden cardiac arrest to address an intractable epidemic: JACC state-of-the-art review". J Am Coll Cardiol 2019;73:70-88.

    View ArticleGoogle Scholar

  • 45. Karam N., Bataille S., Marijon E., et al. "Identifying patients at risk for prehospital sudden cardiac arrest at the early phase of myocardial infarction: the e-MUST Study (Evaluation en Médecine d’Urgence des Stratégies Thérapeutiques des infarctus du myocarde)". Circulation 2016;134:2074-2083.

    CrossrefMedlineGoogle Scholar

  • 46. Gaibazzi N., Siniscalchi C., Reverberi C. "The Heart SentinelTM app for detection and automatic alerting in cardiac arrest during outdoor sports: field tests and ventricular fibrillation simulation results". Int J Cardiol 2018;269:133-138.

    CrossrefMedlineGoogle Scholar

  • 47. Maron B.J. "The paradox of exercise". N Engl J Med 2000;343:1409-1411.

    CrossrefMedlineGoogle Scholar