Sudden Cardiac Arrest in Athletes - Can We Prevent It?

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Sudden cardiac arrest (SCA) is very rare during sports activities 0.76/100,000.  They found only 3 cases that could have potentially been identified by a sports physical prior to competition.  NNT = 146,000.

Why does this matter?
One of the goals of getting a sports physical is to prevent athletes from having sudden cardiac death by identifying them prior to participation.  But how effective is this?

It just feels like you're going to have a heart attack
This was a retrospective review of a Canadian arrest registry that included 18.5 million person-years and found only 3 arrests that may have been prevented with a pre-participation sports physical.  Of the 74 SCA, 43% survived.  Under age 35, the cause was most often primary arrhythmia or structural heart disease; over age 35, coronary artery disease was the most common culprit.  Commotio cordis also occurred in several cases.  The authors concluded, "assuming that all these athletes could have been determined to be at risk for sudden cardiac arrest with the use of screening, at least 146,000 athletes would have had to be screened to identify 1 person who had sudden cardiac arrest during participation in competitive sports."  That's not a very good NNT.

Source
Sudden Cardiac Arrest during Participation in Competitive Sports.  N Engl J Med. 2017 Nov 16;377(20):1943-1953. doi: 10.1056/NEJMoa1615710.

Peer reviewed by Thomas Davis, MD.

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