Mp-453090-1 sports related sudden cardiac arrest in canada: incidence and survival

Sports-related sudden cardiac arrest (SCA) is widely recognized in young competitive athletes, yet recent studies have shown it occurs most frequently in middle-aged, recreational athletes. Few studies have comprehensively described the incidence of sports-related SCA in the general population. To describe sports-related SCA events in 3 Canadian Provinces: Ontario, Saskatchewan, and British Columbia, with a combined estimated population of 7.5 million. C-SCAN is a multidisciplinary network measuring the scope of SCA across Canada. We conducted a cohort study using Emergency Medical Services records from consecutive SCAs ages 18-85 that had no obvious cause, were treated, and occurred during or ≤1 hour after sports activity. The intensity level for each sport was assigned an estimated metabolic equivalent (MET). We defined moderate exercise as a MET score of 3-5.9 and vigorous as ≥6. A total of 14,130 SCAs occurred between Jan 1, 2016 - Dec 31, 2020, of which 272 (1.9%) were sport-related. Most were male (93%; 253/272), with a median age of 60 years [IQR 50, 70]. The overall incidence was 1.2 per 100,000 person-years (95% CI, 1.1-1.3), with males having a 14-fold higher incidence than females 2.3 (95% CI: 2.0-2.6) vs. 0.2 (95% CI: 0.1-0.3) per 100,000 person-years, respectively. SCAs occurred during 35 unique sports (Figure 1); intensity was vigorous (44.9%; 122/272) , moderate (30.5%; 83/272) or uncertain (24.6% ; 67/272). Most took place in recreational facilities (62.1%; 169/272), with high rates of bystander witnessed (73.9%; 201/272) and bystander CPR (79.0%; 215/272). Bystanders applied an AED in 43.4% (118/272) of cases and AED shocks were delivered in 99/118 (84%), when an AED was applied. Median EMS response time was 6 [IQR 5, 9] minutes, with an initial shockable rhythm reported in 51.1% (139/272). Over half of those with known final vital status (52.3%; 134/256) survived to hospital discharge. Sport-specific survival rates were highly variable (Figure 1, Table 1). Almost 30% (74/272) reported symptoms ≤1 hour of sports activity, with chest pain (n=28), shortness of breath (n=18), and dizziness (n=12) being most common. Sports-related SCA occurs infrequently, yet attracts high rates of bystander intervention, resulting in a high proportion of survivors. Data on sport-specific survival and preceding symptoms could help inform risk stratification and public response strategies.Tabled 1Table 1: Characteristics and interventions of sports-related SCAs (n = 272)SportMale cases (n = 253)(n, %)Female cases (n = 19)(n, %)Age (mean, SD)Bystander AED applied (n, %)Survived to hospital discharge (n, %)Hockey43 (17%)0 (0%)56 (12.4)34 (79.1%)31/40 (77.5%)Cycling39 (15.4%)1 (5.3%)63.7 (9.4)4 (10%)17/38 (44.7%)Running/jogging31 (12.3%)3 (15.8%)49.3 (17.1)12 (35.3%)19/30 (63.3%)Ball sports30 (11.9%)3 (15.8%)57 (16.8)16 (48.5%)21/31 (67.7%)Home/gym workout26 (10.3%)2 (10.5%)60.2 (11.6)12 (42.9%)10/27 (37%)Swimming23 (9.1%)4 (21.1%)58.9 (18.2)16 (59.3%)7/27 (25.9%)Racket sports20 (7.9%)0 (0%)65.1 (8.7)9 (45%)14/18 (77.8%)Exercise Class14 (5.5%)5 (26.3%)58.7 (13.2)5 (26.3%)9/17 (52.9%)Winter sports12 (4.7%)0 (0%)64.1 (14.1)7 (58.3%)2/12 (16.7%)Other8 (3.2%)0 (0%)57.2 (17.4)3 (37.5%)3/8 (37.5%)Water sports7 (2.8%)1 (5.3%)55.5 (12.8)0 (0%)1/8 (12.5%)Survival rate calculation includes only those for whom final vital status is known. Open table in a new tab