Dr. Luis Serratosa
Sudden cardiac arrest in sports – need for uniform registration: A Position Paper from the Sport Cardiology Section of the European Association for Cardiovascular Prevention and RehabilitationEE Solberg, M Borjesson, S Sharma et al.; on behalf of the Sport Cardiology Section of the EACPR of the ESC Eur J Prev Cardiol (2015) Aug 18; DOI: 10.1177/2047487315599891
In order to solve the discrepancies and controversies related with incidence and causes of sudden cardiac arrest/sudden cardiac death (SCA/SCD) in sports, the aim of this position paper of the EACPR Sport Cardiology Section is to provide with suggestions for standard definitions as well as uniform methodology for registration and autopsy procedures. Increasing the amount and quality of collected data will hopefully improve the efficiency of our prevention strategies (cardiac pre-participation screening and safety in facilities) in SCA/SCD in sports.
Related with definitions, the document suggests to include in the registry those cases of SCA/SCD occurring during or within 1 to 24 hrs post exercise. Even if it might be a more difficult task, survivors of SCA should of course be included. Athletes should be categorised as recreational or competitive according to the type, level, frequency, intensity and duration of sport participation.
In a recent article, Harmon et al. (1) reported autopsy-negative sudden unexplained death as the most common finding at autopsy (25%) in 64 SCD cases of National Collegiate Athletic Association athletes. As outlined in this position paper, the quality of data in death registries ultimately relies on the standard of pathology and/or clinical assessment by the doctor providing the final diagnosis. As accurate interpretation of the autopsy will also have implications in guiding and avoiding false reassurance in the family evaluation, the cause of SCD in an athlete should ideally be established by a cardiac pathologist, following the guidelines of the Association for European Cardiovascular Pathology.
In order to facilitate a uniform registration and hopefully increase the amount of collected cases, the paper also includes a brief but very complete and easy to fill registration form, requiring data related with the demographics (age, gender, ethnicity) and clinical information of the athlete-patient (family and prior personal medical history, available ECGs and/or other diagnostic tests), as well as characteristics of the sport, circumstances of the SCA and resuscitation procedures (cardiopulmonary resuscitation [CPR], automated external defibrillator [AED] and medical action plan) of the sporting site, outcome and final diagnosis. If possible, climate conditions and behavioural issues such as performance enhancing substances use and/or drug abuse should also be registered.
Despite the probably numerous potential practical, ethical and medico-legal challenges, these recommendations should and hopefully will be used by scientific and sporting organisations to design national registries on SCA/SCD in sports. These organisations would then need to cooperate closely with the national governments and public health authorities of each country, in order to establish and maintain the registries. Ideally and also mentioned in the study among other future objectives, all the sports-related SCA/SCD cases should be integrated in the existing death certificate or registration system.
1) Harmon KG et al. Incidence, Cause, and Comparative Frequency of Sudden Cardiac Death in National Collegiate Athletic Association Athletes: A Decade in Review. Circulation. 2015; 132:10-19.
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