2014 - sudden cardiac death in athletes - aoasm · pdf file sudden cardiac arrest in athletes...

Click here to load reader

Post on 08-Jun-2020

7 views

Category:

Documents

0 download

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

View more