Elsevier

Heart Rhythm

Volume 5, Issue 6, June 2008, Pages 794-799
Heart Rhythm

Original-clinical
Survival trends in the United States following exercise-related sudden cardiac arrest in the youth: 2000–2006

https://doi.org/10.1016/j.hrthm.2008.03.001Get rights and content

Background

Sudden cardiac arrest is the leading cause of death in young athletes. However, limited studies have examined survival rates after exercise-related sudden cardiac arrest in the youth.

Objective

The Purpose of this study was to monitor exercise-related sudden death in the United States and to assess survival trends following exercise-related sudden cardiac arrest in the youth.

Methods

From January 1, 2000, through December 31, 2006, exercise-related sudden death events in young individuals were identified through a systematic search of public media reports. Media reports were reviewed to clarify case circumstances and relation to exercise, cause of death, outcome, and use of a defibrillator. The study used an observational cohort design with weekly searches and updates to the database.

Results

During the 7-year period from 2000–2006, 486 total cases of exercise-related sudden cardiac arrest were identified in elementary school (age 5–11 years), middle school (age 11–14 years), high school (age 14–18 years), and college (age 18–22 years) individuals in the United States, with an average of 69 cases per year (range 48–96 years). Eighty-three percent (405/486) of victims were male and 17% (81/486) were female, with a male-to-female ratio of 5:1. Overall survival during this time period was 11% (55/486), with a range of 4% to 21% survival per year. There was a statistically significant trend toward improved survival in recent years (P = .035). Females were more likely to survive sudden cardiac arrest than were males (21% vs 9%, P = .001).

Conclusion

Survival following exercise-related sudden cardiac arrest in the youth has been universally poor over the last 7 years in the United States, despite a recent trend toward improved survival. Improved reporting systems are needed to accurately monitor these events, and strategies to improve outcomes from exercise-related sudden cardiac arrest in the youth, such as improved emergency response planning and public access defibrillation programs, should be considered.

Introduction

Exercise-related sudden death in young individuals is a catastrophic event with far-reaching emotional and social impact on communities.1, 2, 3 The vast majority of these sudden deaths are due to a variety of structural cardiovascular abnormalities (i.e., cardiomyopathies) and primary electrical diseases (i.e., channelopathies) that go undetected in otherwise healthy appearing athletes.1, 2, 3, 4, 5, 6, 7, 8, 9 Although such cardiac events are reported to be uncommon, the true incidence of exercise-related sudden cardiac arrest (SCA) is unknown.2, 10, 11 In the United States, evaluation of SCA in young athletes is limited by the lack of a mandatory reporting system for juvenile sudden death. Studies to date have relied on survey or nonmandatory reporting systems that likely underestimate the true incidence of SCA in athletes.2, 3, 7 Available studies have estimated the annual incidence of sudden cardiac death in high school-aged athletes to be 1:100,000 to 1:300,000 and 1:65,000 to 1:69,000 in college-aged athletes.2, 4, 10, 11, 12 More recently, intensive search of public media reports and other electronic databases has identified a larger number of cases of SCA in athletes than previously established. The Sudden Death in Young Athletes Registry in the United States has identified approximately 115 cases of SCA per year in young competitive athletes, or about one case of sudden death every 3 days in the United States in organized youth sports.13 Thus, with approximately five million competitive high school athletes and 500,000 competitive collegiate athletes, a more accurate estimate of the annual incidence of SCA in young athletes is approximately 1:50,000 athletes.

Prior studies of sudden cardiac death in athletes have focused mostly on determining the etiology and incidence. Limited studies have examined survival rates after SCA in young athletes. These reports have found rather dismal survival rates despite the otherwise good health and conditioning of the young athletes with SCA. In a small series of collegiate athletes, the survival rate was 11% despite timely resuscitation in most cases.14 In the U.S. Commotio Cordis Registry, the overall survival rate was found to be 16%.15

The purpose of this study was to monitor exercise-related sudden death in the United States and to assess survival trends following exercise-related SCA in the youth.

Section snippets

Methods

From 2000–2006, exercise-related sudden death events in young individuals were identified through a systematic search of public media reports. The search was conducted by members of Parent Heart Watch, a national organization and support network of parents and families of children affected by SCA dedicated to preventing sudden cardiac death in the youth. During this 7-year period, approximately 15 hours per week was spent performing Internet-based searches using three search engines (Google,

Results

During the 7-year period from 2000–2006, 521 total cases of exercise-related sudden death were identified in the United States in elementary school, middle school, high school, and college-aged individuals. The age range for cases based on school level was 5–11 years for elementary school, 11–14 years for middle school, 14–18 years for high school, and 18–22 years for college. Of these 521 cases, 35 were excluded from further analysis after the cause of death was determined to be noncardiac (

Discussion

To our knowledge, this is the largest study assessing survival following exercise-related SCA in young individuals in the United States. Although this study was not designed to calculate the true incidence rate of exercise-related SCA, an average of one to two cases per week were identified in the United States over the last 7 years. It also is likely that not all cases were identified due to underreporting and limitations in the search process.

This study identified a higher proportion of

Conclusion

Survival following exercise-related SCA in young individuals has been poor over the last 7 years in the United States. Despite the poor survival rate, there is a statistically significant trend toward improved survival in recent years, and there may be a concurrent trend toward increased AED use. Females were found to have a higher survival rate than males, and this finding requires further research to identify contributing factors. This study highlights the need for improved reporting systems

Acknowledgements

We are grateful to the Parent Heart Watch organization for their collaboration and tireless efforts in searching for cases of exercise-related sudden cardiac arrest in the youth. We thank Carol Fahrenbruch, MSPH, for statistical support and analysis.

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  • Cited by (0)

    Dr. Drezner is on the Medical Advisory Board for Parent Heart Watch, the Medical and Scientific Advisory Board for the Sudden Cardiac Arrest Association, and the Scientific Advisory Board for Heart Screen America, for which he also is a partial stockholder. Dr. Drezner is the Director of the National Registry for AED Use in Sports and has received grant funding from the National Operating Committee on Standards for Athletic Equipment to study emergency planning and sudden cardiac arrest in the athletic setting. Mrs. Derminer is the Executive Director of Parent Heart Watch.

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