Exercise-related cardiac arrest has better outcome than non-exercise-related arrest

Berdowski J, de Beus MF, Blom M, et al.
Eur Heart J. 2013 Oct 3. [Epub ahead of print]

Background

Despite the beneficial effects of regular exercise on cardiovascular disease, acute mainly vigorous exercise increases the risk of an acute cardiac event during and immediately after the activity [1,2]. Population-based information on the incidence and prognosis of exercise-related out-of-hospital cardiac arrests (OHCA) is scarce [3].
This study assessed the incidence of exercise-related OHCA in the general population and whether these are associated with higher survival rates than non-exercise-related OHCAs. The study benefitted from the prospective database of all resuscitation efforts in the Dutch province of North-Holland maintained by the Amsterdam Resuscitation Studies (ARREST). Many public places such as supermarkets, sport centres and office buildings in the Netherlands are equipped with an automated external defibrillator (AED), such that trained lay rescuers can attach this AED prior to arrival of more specialised help.

Main results

• 143 (5.7%) out of 2524 OHCA cases were exercise-related.
  Exercise-related OHCAs occurred more often in public places, and had higher rates of bystander cardiopulmonary resuscitation (CPR) and AED use, and were more likely to have a shockable initial rhythm (ventricular fibrillation or rapid ventricular tachycardia)than non-exercise-related OHCAs.
• Incidence of exercise-related OHCA was 2.1 per 100000 person-years (py) and occurred more often in men than in women (4.0 vs. 0.3 per 100000 py).
  The incidence of non-exercise-related OHCA was 35.5 per 100000 py, and much higher in men than in women (52.1 vs. 19.4 per 100000 py).
• Exercise-related OHCA occurred less often in patients younger than 35, than in older people (0.3 vs. 3.0 per 100000 py). Survival from exercise-related arrest was higher in persons over 35 years old than in younger patients (47.8% vs. 14.3%, P=0.009).
• 46.2% of the 143 people suffering from an exercise-related OHCA survived, as compared to 17.2% in non-exercise-related OHCA (OR: 4.12, 95%CI: 2.92-5.82, P<0.001). The association between exercise-related OHCA and survival remained significant in a multivariable model that corrected for age, gender, location, bystander witness, initiation of bystander CPR, AED use, initial rhythm and Emergency Medical System response time (adjusted OR: 2.63: 95%CI: 1.23-5.54, P=0.01).

Conclusion

This study demonstrates that the incidence of exercise-related OHCA is low, in particular in young people. It also shows that exercise-related OHCA has a favourable outcome, as compared to non-exercise related arrests: 46% of the victims survive, as opposed to 17% in non-exercise-related circumstances. Prompt bystander initiation of CPR with the use of an AED is likely a key factor in improving outcome.

References

1. Thompson PD, Franklin BA, Balady GJ, et al. Exercise and acute cardiovascular events placing the risks into
perspective: a scientific statement from the American Heart Association Council on Nutrition, Physical Activity, and Metabolismand the Council on Clinical Cardiology. Circulation 2007;115:2358–2368.
2. Corrado D, Basso C, Rizzoli G, et al. Does sports activity enhance the risk of sudden death in adolescents and young adults? J Am Coll Cardiol 2003;42: 1959–1963.
3. Marijon E, Tafflet M, Celermajer DS, et al. Sports-related sudden death in the general population. Circulation 2011;124:672–681.

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