Having your heart stop while playing a sport is very unusual, and
fewer than 1 in 5 cases of sudden cardiac arrest among competitive
amateur athletes would have been predicted by a screening
examination, the authors of a study from Canada say.
"Our results indicate that sudden cardiac death during participation
in competitive sports is rare, the causes are varied, and more than
80% of cases would not have been identified with the use of
systematic (screening)," the research team, led by Dr. Paul Dorian
at the University of Toronto, reported in The New England Journal of
Not only do screening programs exclude people who could safely
engage in sports, he told Reuters Health by phone, the money spent
on them could be better used by having defibrillators handy at
competition sites and training people to use them.
"In a way, it's a sobering finding because I think the assumption
has been that if we were aggressive at screening, we could greatly
improve the problem," said Dr. Ben Abella, professor of emergency
medicine at the Perelman School of Medicine at the University of
Pennsylvania, who was not involved in the research.
"And while I think screening may have an important role, this study
highlights another important consequence. We need to prepare
athletic trainers and venues for the event of cardiac arrest," he
told Reuters Health by phone.
The analysis looked at every instance of cardiac arrest that
occurred from 2009 through 2014 in people age 12 to 45 among 6.6
million residents in the southern Ontario area.
During that time, there were 74 sport-related cardiac arrests. Only
16 of the 74 occurred during or within an hour of playing a
competitive sport; the rest were among people involved in a
non-competitive sport, where no formal league was involved.
And only 3 of those 16 cases "were determined to have been
potentially identifiable if the athletes had undergone participation
screening," said the researchers.
Dr. Dorian and his team calculated that the odds of an athlete
developing a sudden arrest during competition or training was 1 in
131,600 per year, with 44% surviving to be discharged from the
To put that in perspective, the odds of a sudden cardiac arrest
among the general population age 12 to 45 is about 6 times higher -
or 1 in 20,700 per year.
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"The risk in these athletes is extraordinarily small, less than
what's previously been believed," although it may seem higher
because such instances of sudden death are shockingly unexpected and
widely publicized, said Dr. Dorian, who is also a cardiologist at
St. Michael's Hospital. "That's not to say it doesn't happen. I
don't want to minimize the individual tragedies for families, loved
ones and teammates."
The group was not able to calculate the odds for people engaged in
non-organized competitions because of uncertainty over the number of
people involved and their degree of effort.
Among athletes under 35, structural and primary arrhythmias were the
most common causes of sudden cardiac arrest. For ages 35 to 45, the
most common cause was coronary artery disease.
"It's been assumed without any proof that more than half of
individuals that are destined to die suddenly or have a cardiac
arrest can be detected if you have these screening programs," said
Dr. Dorian. "What we've shown is the most common disorders that lead
to cardiac arrest are the kinds of disorders which are not
detectable with these screening programs."
"We need automated external defibrillators available," said Dr.
Abella. "We need trainers or security staff or coaches trained in
CPR and emergency response, because we're not going to prevent this
problem by screening."
And the biggest problem with the screening programs, Dr. Dorian
said, is that they raise a false alarm in too many amateur athletes.
"Screening athletes is likely to cause more harm than benefit," he
said. "It's the worry, concern, fright - which is mostly unnecessary
- that these young individuals and families have to undergo when
they're identified as maybe having a problem while they're waiting
for test results."
"And even if a problem comes up, in fact, the risk would likely be
very, very small," said Dr. Dorian. “For the majority of people, the
benefits of participating in competitive sports far outweigh any
risk of sudden cardiac arrest.”
N Engl J Med 2017.
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