2014 - sudden cardiac death in athletes - aoasm · pdf file sudden cardiac arrest in athletes...
Post on 08-Jun-2020
7 views
Embed Size (px)
TRANSCRIPT
11/4/14
1
Sudden Cardiac Arrest in
Athletes
Kimberly G. Harmon, MD Professor, Department of Family Medicine and
Orthopaedics and Sports Medicine
Osteopathic Medicine Conference and Exposition Seattle, WA October 28, 2014
Hank Gathers
March 4, 1990
Marc Vivan Foe June 26, 2003
Reggie Lewis July 27, 1993
Sergei Grinkov 1995
Darryl Kile June 22, 2001
Atlanta Hawks
Damion Nash Denver Broncos February 24, 2007
Antonio Puerta 1984 - 2007
11/4/14
2
Media Hype?
• Incidence • E5ology
Maron, JACC, 2014
It is important to place into proper perspective these absolute numbers of sudden deaths, because the frequency of these events is a very important variable in the screening debate.
11/4/14
3
Sudden deaths attributable to cardiovascular disease in young athletes in the United States occur at an annual rate similar to lightning strike fatalities.
http://www.lightningsafety.noaa.gov/fatalities.htm
Maron, JACC, 2014
http://www.lightningsafety.noaa.gov/fatalities.htm
In order to calculate a
RELIABLE INCIDENCE a precise number of events (numerator)
AND the popula5on at risk (denominator) needs to be iden5fied.
11/4/14
4
Incidence of Death from Lightening Strikes
• Average of 32 deaths/year over the last 8 years in the U.S.
• 361,100,000 people in the U.S. -‐ 2013
361,100,000 people 32 deaths from lightening
1 death in
11,284,375 people
High Risk Groups
1 in 614,749
1 in 249,550
Tradi5onal Es5mates
Sudden Cardiac Death
Incidence
1 : 200,000 – 1 : 300,000
• Con5nues to be perpetuated despite more recent evidence with beXer methodology
11/4/14
5
SCD Incidence Evalua&ng the Science
• Difficult to compare studies with different methodologies
• Need to compare similar cohorts
• Type of popula5on – Compe55ve athletes – Recrea5onal athletes – Exercisers – Youth
• Age range studied • Time frame
– Exer5onal death – Death at any 5me
SCD Incidence Evalua&ng the Science
SCD Incidence Evalua&ng the Science
• Ac5ve Surveillance – Purposeful gathering of informa5on from a defined popula5on
– O_en mandatory repor5ng requirements • Passive Surveillance
– Repor5ng of only those with disease (SCD) – No special effort is made to find those with unsuspected disease incidents
– Subject to ascertainment bias
11/4/14
6
Where did tradi5onal es5mates come from?
1 : 200,000 – 1 : 300,000
• Data from the Na5onal Center for Catastrophic Sports Injury Research 1983 -‐ 1993
• Passive surveillance – Informa5on from NCAA, NFHS, NJCAA, NAIA, Community College League of California
– Press clipping service – Deaths during or within 1 hour of par5cipa5ng on a college or high school team
VanCamp S, Bloor C, Mueller F, Cantu R, Olson H Med Sci Sports Exer;1995
• 17 sports selected for analysis • Adjusted for athletes that par5cipated in more than one sport – 1.9 for high school, 1.2 for college – “based with discussion on the representa&ve from the na&onal athle&c organiza&ons”
• Club and intramural teams not included • Incidence of SCD in high school and college athletes was 1 in 300,000
VanCamp S, Bloor C, Mueller F, Cantu R, Olson H Med Sci Sports Exer;1995
11/4/14
7
Limita5ons
• Passive surveillance • Only exer5onal deaths • Somewhat random denominator
• Used insurance claims data – In Minnesota all high school athletes are covered by death benefit of $10,000
• Reviewed 1985-‐86 to 1996-‐1997 (12 years) • Had a precise denominator
– Grades 10 – 12 – 3 death claims made – All male
JACC, 1998
• There were 1,453,280 sports par5cipa5ons • Average number of sports per athlete for 1996-‐1997 was 2.23
• Total number of athletes was 651,695 • Rate of SCD was 1 in 217,400
11/4/14
8
Limita5ons
• Only athletes par5cipa5ng in a school-‐ sponsored team sport (no club or intramural) – Would not count:
• Varsity soccer player who died playing on their club team
• College football player who died playing intramural basketball
• Only exer5onal deaths
Ac-vity at Time of Death
Study Popula-on Sleep Moderate/
vigorous physical ac-vity
Harmon 2014
NCAA athletes 17-‐24
41% (or non-‐exer5on) 59%
Winkle 2013
Children 1 -‐ 18
32% 14%
Pilmer Children 1-‐ 19 41% 16%
2013 15-‐19 30% 23%
Margey 2011
People 14 – 35
45% (or non-‐exer5on) 8%
Harmon 2011
NCAA athletes 17-‐24
33% (or non-‐exer5on) 58%
Eckart 2011 US military 18-‐35
-‐ 47%
Holst 2009
Persons 1 – 35
34%
• Registry from the Department of Defense • Ac5ve surveillance • Mandatory; autopsy protocol • 10 years; 15.2 million person-‐years • Incidence of SCD in 18-‐25 1 in 25,000
JACC 2011
11/4/14
9
Incidence of SCD
400,000 student athletes annually Know sports, sex and ethnicity of par5cipants High profile
• NCAA has no requirement for repor5ng deaths
• Case iden5fica5on – NCAA Memorial Resolu5ons List – Parent Heart Watch Database (media database) – Catastrophic insurance claims
• Capture-‐recapture analysis (90 – 100%)
Circulation. 2011;123:1594-600
Accidents 51%
Drug Overdose 2%
Cancer 7%
Cardiac 16%
Heat stroke 1%
Meningi-s 1%
Other medical 3%
Suicide 9% Homicide
6%
Unknown 2%
Heat stroke -‐ sickle cell related
2%
Harmon, Circulation, 2011
All Cause NCAA Death 2004 - 2008
11/4/14
10
Risk break down
Group Incidence
Overall 1 in 43,770
Males 1 in 33,134
Females 1 in 76,746
African-‐American 1 in 17,696
Caucasian 1 in 58,653
Risk by sport
Sport Incidence
Basketball 1 in 11,394
Swimmi