Data from a nationwide registry on sports-related sudden cardiac deaths in Germany

Abstract

BackgroundProspective national registries examining the incidence and aetiology of sports-related sudden cardiac death (SrSCD) not only in competitive athletes but also in recreational sports participants are uncommon. In May 2012, a prospective registry on SrSCD was installed to examine the incidence and particularly the aetiology of such events in the general population in Germany.MethodsThe registry consists of a web-based platform to record SrSCD cases. Media-monitoring and cooperation with 15 institutes of forensic medicine complemented the search. SrSCD was defined as death occurring during sports activity or up to 1 hour after its cessation, regardless of successful resuscitation. We included subjects at all levels of competition as well as recreational athletes.ResultsAfter 30 months of observation, 144 SrSCDs were recorded (mean age 46.8 ± 16.2 years). The overall incidence was 1.2–1.5/million/year, with 97% being male. Most of the cases occurred in the context of non-elite competitive or recreational sports. Football and running were the most common disciplines. In subjects ≤35 years, myocarditis prevailed, whereas in athletes ≥35 years, CAD predominated by far. Few cardiomyopathies were observed.ConclusionsIn Germany, the largest proportion of SrSCDs occurs in middle-aged men during recreational sports or non-elite competitive sports. The distribution of cardiac diseases responsible for SrSCD seems to vary among European countries. Our findings may indicate the need for a larger focus on myocarditis prevention in the young as well as widening the screening scope to younger athletes below the ‘elite’ level and to senior athletes.

Exercise‐Related Out‐of‐Hospital Cardiac Arrest Among the General Population in the Era of Public‐Access Defibrillation: A Population‐Based Observation in Japan

“…Consistent with previous reports,6, 22, 29, 30, 31 the majority of exercise‐related OHCAs among the general population were observed in men. The reasons for these differences between the sexes could not be determined from our data and may result from variations between men and women in exercise participation rates and duration or level of exertion during each exercise session.…”

“…Consequently, the exercise‐related OHCAs in our study were limited to cardiac arrests occurring during exercise. Previous studies estimated the proportion of cardiac arrests occurring during sports activities as ranging from 66% to 92% of all exercise‐related arrests;6, 22, 30, 31 therefore, the exercise‐related OHCA incidence rate in our study may be an underestimation.…”

“…Reports indicate that the incidence rate of exercise‐related OHCA among the general population varies according to study location: 22 (per million population per year) in the United States, 21 in The Netherlands, 6 in England, 5 in France, and 1 in Germany 6, 22, 29, 30, 31. These figures, however, cannot be directly compared with those in our study, owing to differences in participant ethnic distribution, exercise participation rates, target age range, study period, methodology for selecting the study population, and definition of exercise‐related OHCA.…”

Sports-related sudden cardiac deaths in the young population of Switzerland

“…Interestingly, in the same study, HCM was observed 8 times more frequently than ARVC (251 vs. 30 cases). We observed a high number of deaths caused by premature CAD and a low number of cases with ARVC and HCM in our cohort, which is in line with reports from Denmark, Germany, Norway and Ireland [19, 20, 25, 26]. The differences between the aforementioned studies support the theory that regional differences in population characteristics play a central role in the epidemiology of SCD, particularly in athletes [8].…”

The most common cause of sudden cardiac death in athletes

“…On the contrary, in the registry from Germany published in 2015, HCM was identified as a reason in only 5% of athletes. The most common cause of death of athletes under the age of 35 was myocarditis (10). In Italy, that was arrhythmogenic right ventricular cardiomyopathy (23).…”