Sports-Related Sudden Cardiac Arrest in Canada: Incidence and Survival

Abstract

Background: Sports-related (Sr-) sudden cardiac arrest (SCA) is widely recognized in young competitive athletes, yet occurs more frequently in middle-aged, recreational athletes. Our objective was to describe the epidemiology and characteristics of Sr-SCA in 5 Canadian Provinces (population: 10.9 million).

Methods: We conducted a retrospective cohort study using emergency medical services records from consecutive out of hospital SCAs, for patients aged 18-85 years, who were treated, and whose SCA was from a presumed cardiac cause, during or ≤ 1 hour after sports activity.

Results: A total of 18,769 SCAs occurred between January 1, 2016 and December 31, 2020, of which 339 (1.8%) were sport-related. Most patients were male (93.8%; 318/339), with an average age of 58.1 ± 14.3 years old. The incidence of Sr-SCA was 1.2 per 100,000 person-years (95% confidence interval [CI], 1.1-1.4). Men had an almost 16-fold greater incidence than women (2.3 [95% CI, 2.1-2.6] vs 0.2 [95% CI, 0.1-0.2] per 100,000 person-years). Sr-SCAs occurred during 52 unique sports. Almost two-thirds occurred in recreational facilities (60.2%; 204/339), with high rates of bystander witnessed (75.6%; 256/339) and bystander cardiopulmonary resuscitation (73.6%; 248/337). Bystanders delivered automated external defibrillator shocks in 121 of 335 (36.1%) cases. Median emergency medical services response time was 6.2 (interquartile range, 4.8-8.9) minutes, with an initial shockable rhythm reported in 76.9% (249/324). More than half of those with known final vital status (52.0%; 167/321) survived to hospital discharge, which varied on the basis of sport.

Conclusions: Sr-SCA occurs infrequently, attracts high rates of bystander intervention, and has high survivability.