Lower risk of sudden cardiac arrest during sports in older adults

Benefits of regular exercise likely outweigh lower risk of sports-related sudden cardiac arrest among community-dwelling US adults age 65 and older, new study suggests It has been.

An analysis of sudden cardiac arrest events in nearly 2 million older adults in Portland, Oregon and Ventura County, California found that sports-related events were rare in this population and that all sudden cardiac arrests over the age of 65 were rare. was shown to account for only 1.9% of It is older and occurs predominantly (91%) in men.

Furthermore, compared with those who experienced a nonsport-related sudden cardiac arrest (SCA) event, those with sport-related sudden cardiac arrest (SrSCA) were more likely to have hypertension, diabetes, obesity, or hyperlipidemia. The burden of cardiovascular risk factors such as

“As an endurance runner cardiologist, I am a strong believer in the benefits of exercise,” said Sumeet S. Chugh, M.D., of Cedars-Sinai Health System in Los Angeles. theheart.org| Medscape Cardiology“However, we were still surprised by the very low annual incidence of SrSCA in the two communities.”

“The benefits of sports activity in the elderly are likely to far outweigh the risks,” he said. It may have gone undetected or an unexpected clinical event occurred.”

The study was published online on January 18. American Journal of Cardiology: Clinical Electrophysiology.

Reduced risk or comorbidities

In two large, prospective trials of 1.85 million participants, the researchers compared all resuscitation attempts in the Portland metropolitan area (2002–2017) and Ventura County (2015–2021). We investigated out-of-hospital SCA. A patient who developed her SCA during or within 1 hour after cessation of sport activity was considered SrSCA.

Sports activities were defined as physical activities undertaken for recreation or for the maintenance of strength or skill. “Gym activities” included all activities that older people might do in a gym, Chug said.

Of the 4078 SCAs, 77 were SrSCA (1.9%; 91% male). Based on conservative estimates of community residents aged 65 years and older who participate in sporting activities, the incidence of SrSCA was 28.9 per 100,000 sporting-years in Portland and 18.4 per 100,000 years in Ventura.

The majority (77%) of SrSCA occurred during sports activities (most commonly running, cycling, and gym activities). 17% occurred within 1 hour after quitting smoking. 6% could not be classified in either category.

Twenty (26%) patients with SrSCA had warning symptoms, most commonly chest pain (55%), 24 hours before the event. Three (15%) had seizures and the rest had nonspecific symptoms such as dizziness and nausea.

Among patients with available medical records (47 SrSCA and 3,162 non-SrSCA), SrSCA patients were more likely to have heart failure (17% vs. 38%), COPD/asthma (15.6%) compared with non-SrSCA patients. %) had a low prevalence of clinical comorbidities. vs 35.8%), and hypertension (57.8% vs 80.1%). It also significantly reduced the burden of cardiovascular risk factors such as hypertension, diabetes, hyperlipidemia, smoking and obesity.

However, the prevalence of previously diagnosed coronary artery disease and myocardial infarction was similar between groups (48.9% vs. 48.1% and 27.7% vs. 25.4%, respectively).

In addition, SrSCA was associated with a higher percentage of rhythms that were witnessed and shocked by bystanders as well as in public places. This gave him a 4-fold higher survival outcome than non-SrSCA.

“Sports activities in older adults should be encouraged, and these findings provide data that can be provided to patients to help them balance risks and benefits,” Chugh said. .

“It is important to follow clinical guidelines when providing exercise/sport prescriptions,” he added.

For older adults who are new to exercise, researchers recommend gradually increasing physical activity over 6 to 8 weeks. A previous review by Chough and Joseph B. Weiss, MD, provides an overview and details of increased participation in sports among older adults.

hot topic

comments on the study of theheart.org| Medscape CardiologyNikhil Warrier, M.D., medical director of electrophysiology at the Memorial Care Heart & Vascular Institute at Orange Coast Medical Center in Fountain Valley, California, said earlier this month professional football player Damar Hamlin’s SCA aired on national television. “This has been a hot topic. [the study] Profile with an overall healthy lifestyle and very low cardiovascular complications. As a result, this study will have a significant impact in addressing this topic. “

“The limitations of this study are well described and are primarily related to data collection as this is not a randomized trial,” said Warrier, who was not involved in the study. increase. “Additional studies examining which patients would benefit from preparticipation exercise screening would be ideal to stratify the risk of these asymptomatic patients.”

Clinical assessment of symptoms occurring during physical activity may also play an important role in assessing individual risk, he added. The overall benefits of sports activity likely outweigh the low risk of SrSCA in this patient population.”

No commercial funding or related financial relationships have been reported.

J am Koru Cardior EPPublished online on January 18, 2023.

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