Mortality improves for sports-related sudden cardiac arrest
Mortality from sports-related sudden cardiac arrest decreased in France due to an almost tripling of the survival rate; however, incidence remained stable, suggesting more prevention efforts are needed.
In an analysis of hospital data published in the Journal of the American College of Cardiology, researchers found that more frequent basic life support implementation by bystanders, including a threefold increase in the rate of bystander CPR and an 18-fold increase in the rate of automated external defibrillator use, account for the improved outcome, with a survival rate at hospital discharge reaching 67% during the last 2-year study period.
“The most significant results were observed in sports facilities where major efforts have been undertaken with respect to both public education and AED deployment, leading to an outstanding 90% rate of bystander CPR in witnessed sudden cardiac arrest and a survival rate that exceeded 75% at hospital discharge,” Nicole Karam, MD, PhD, an interventional cardiologist at European Hospital Georges Pompidou, Paris, and colleagues wrote.
Increased bystander intervention
Karam and colleagues assessed temporal trends in sports-related sudden cardiac arrest incidence, management and survival, using data from the French Institute of Health and Medical Research. Researchers analyzed data from 377 sports-related sudden cardiac arrest events, including evolution of incidence, prehospital management, and survival at hospital discharge during six successive 2-year periods from 2005 to 2018.
Among the 377 events, 5.3% occurred in young competitive athletes and 94.7% occurred in middle-aged recreational sports participants.
Comparing the last 2-year with the first 2-year period, sports-related sudden cardiac arrest incidence remained stable at 6.24 vs. 7 per million inhabitants per year (P = .51), with no between-group differences in mean age (47 years vs. 51 years; P = .42), sex (men, 94.7% vs. 95.2%; P = .99) and history of heart disease (12.5% vs. 15.9%; P = .85). However, comparing the first 2-year period to the last 2-year period, the frequency of bystander CPR increased from 34.9% to 94.7% (P < .001). Public AED use similarly increased, from 1.6% to 28.8% (P = .006).
Survival to hospital discharge improved steadily, reaching 66.7% in the last study period compared with 23.8% in the first (P < .001).
“Sports-related sudden cardiac arrest incidence remained stable over the last decade, while its mortality burden significantly decreased because of a threefold increase in the survival rate, mainly through improved resuscitation,” the researchers wrote. “These positive results should encourage similar efforts to improve resuscitation and outcomes in all sudden cardiac arrest in the general population.”
‘Minimal progress made’ in prevention
In a related editorial, Michael J. Ackerman, MD, PhD, and John R. Giudicessi, MD, PhD, of the Windland Smith Rice Genetic Heart Rhythm Clinic at Mayo Clinic, noted that the findings demonstrate the “impressive impact” of increased bystander CPR awareness and improved public AED access; however, the stable incidence of sports-related sudden cardiac arrest from 2005 to 2018 is “sobering.”
“The postulated effect of increased sports participation aside, this finding seems to indicate that minimal progress has been in made in terms of preventing sports-related sudden cardiac arrest in the first place, over the past decade,” Ackerman and Giudicessi wrote. “Considering the substantive advances in our understanding of the pathogenesis of sudden cardiac arrect-predisposing conditions, particularly as it relates to young individuals ... this finding suggests that the field has been unable to translate this wealth of knowledge into the implementation and/or optimization of effective sports-related sudden cardiac arrest prevention strategies.”
Ackerman and Giudicessi wrote that that future proactive strategies will likely need to build upon standard approaches, such as the American Heart Association 14-point clinical history and examination, with or without a 12-lead ECG, to one day meet or exceed the impact that reactive strategies have had on sports-related sudden cardiac arrest outcomes over the past decade.
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