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Sudden heart attacks in sport – tackling prevention challenges

Big gaps in basic knowledge about the numbers and causes of apparently inexplicable heart attacks among young sportsmen and women are seriously hampering our ability to prevent them, according to a report1 published recently in the British Journal of Sports Medicine.

Reliable databases of all such events across sport are needed, to start plugging these knowledge gaps, say Dr Richard Weiler (Department of Sports Medicine and Sports Science, West Ham United Football Club, Essex, UK) and colleagues. 
His comments come in the wake of the recent high profile case of premier league footballer, Fabrice Muamba, who collapsed on pitch in front of a stadium packed with spectators after sustaining a sudden myocardial infarction.

Fortunately Mr Muamba recovered, but his collapse was followed the next month later by the on-pitch death of Italian footballer Piermario Morosini, who suffered a fatal cardiac arrest during a match in Pescara, Italy. Cases like these are still likely to occur despite screening programmes, and they are poorly understood, says Dr Weiler.

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Dr Richard Weiler

These cases have prompted improvements in pitch-side and acute sports medicine, including emergency life support, defibrillation and the development of practical education courses and emergency care guidelines, says Dr Weiler.
 Nonetheless, he says: “We still lack many answers to basic questions about these afflictions. We do not know the exact numbers and trends in prevalence or incidence, and do not understand the [multiple causes] that trigger sudden cardiac death in previously healthy athletes”.

Issues that still need further investigation are the roles of gender and ethnicity, geography and genes, he says.
 For example, Sub-Saharan Africa may be a “cardiac hotspot,” with recent research linking sudden heart attacks to sickle cell trait. 
 
Other research suggests that African Americans are three times more prone to sudden cardiac death/arrest than white athletes, although the rates vary considerably depending on the type of sport played.

Screening programmes throw up a considerable number of false positive results, and it is still far from clear whether screening actually cuts the number of deaths, whether it is cost effective, and how to manage any abnormal findings, he says.  “It is vital that we start to answer these questions based on reliable science and evidence,” he insists. “To achieve this, we propose the collection and recording of reliable data across sport of every sudden cardiac death/arrest,” he writes.

But for this to happen, cooperation and collaboration will be needed among sporting organisations, federations, and clubs, in addition to the establishment of sport specific and national registries for these incidents, he suggests.
 Dr Weiler cites a FIFA (International Football Federation) initiative that requires a medical assessment before a match for all FIFA competitions, and includes a recently established database for all its 208 member associations in a bid to build up an evidence base and better understand the condition.

“This is one of many efforts needed to fill knowledge gaps and enable us to mitigate the risks of sudden cardiac arrest/death,” concludes Dr Weiler, adding that minimum standards of pitch-side medical care across all sports are essential.

Speaking to BJC Arrhythmia Watch, Dr Weiler said: “Sudden cardiac arrest (SCA) and sudden cardiac death (SCD) are thankfully rare in sport, but this has slowed our ability to learn and adapt best practice. National registries will allow us to fill many basic gaps in our knowledge about SCA/SCD, so that we can work towards mitigating the risks and prevent more cases in future”.

“This will provide us with a more accurate indication of the risk factors for the condition in sport, which is thought to be rare, and provide much needed focus for further research. By answering basic questions, current speculation will be replaced by facts and it is possible that the debate on the pros, cons and evolution of screening programmes will become clearer and their effectiveness better understood,” he added.

References

1. Weiler R, Goldstein MA, Beasley I, Drezner J, Dvorak J. What can we do to reduce the number of tragic cardiac events in sport? Br J Sports Med 2012. doi:10.1136/bjsports-2012-091252.

Published on: May 24, 2012

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