Most Sudden Cardiac Deaths in Young People Do Not Occur During Sports

Marlene Busko

November 06, 2012

TORONTO — About three-quarters of sudden cardiac deaths in people under age 40 occur in the home--not in the sports arena or on the playing field--according to a study presented here at the Canadian Cardiovascular Congress 2012.

Researchers investigated the incidence of sudden cardiac death in two- to 40-year-olds living in Ontario in 2008. They found that most deaths occurred in men (76%) aged 18 to 40 (90%).

Speaking to heartwire , study author and scientific chair of the CCC, Dr Andrew Krahn (University of British Columbia, Vancouver), said three key messages emerge from the data.

"First, it gives us . . . a sense of the scope of the problem," he noted. "Our best estimate is that about 500 young people under the age of 40 die suddenly from heart disease every year in Canada."

Second, "Exercise is not the major context in which young people die suddenly, and targeting athletic facilities as the only place to really make an impact is not going to be very successful."

Third, "If you put an automatic external defibrillator [AED] [in a football stadium or hockey arena], you're much more likely to resuscitate a grandfather watching the game than you are his grandson who is playing the sport."

The group performed a population-based, retrospective, cohort study using data from the Ontario chief coroner's office. They identified 174 cases of presumed sudden death in a population of about 6.6 million people under age 40.

The number of cases of sudden cardiac death increased with increasing age:

  • Age 2 to 18 years: 0.7 per 100 000 person-years.

  • Age 19 to 29 years: 2.4 per 100 000 person-years.

  • Age 30 to 40 years: 5.3 per 100 000 person-years.

Most deaths occurred at home (72%).

Only a third of events in children and adolescents and 9% of events in adults, occurred during exercise. Among those who were exercising, a third had been doing vigorous exercise and 9% had been engaged in moderate exercise.

There was no link between sudden cardiac death and participating in organized, competitive sports such as football or hockey.

Identifying people at risk is like trying "to pick out that needle in a haystack," Krahn noted. However, the study does offer insight into potential strategies to prevent sudden deaths.

It suggests that it is important to try to identify hidden structural heart disease and primary arrhythmia syndromes in this young population. Fainting can be a clue for an impending cardiac event.

Structural heart disease was common, found in 126 of 174 individuals who died of sudden cardiac death (72%). But in 98 of 126 individuals (78%), the disease had not been recognized when they were alive.

Compared with people who were in their 30s when they died from sudden cardiac death, those who were younger at the time of death were three times more likely to have a primary arrhythmia syndrome.

AEDs need to be available wherever the public congregates--such as schools, malls, and other public areas, Krahn said. "We're not trying to selectively save athletes; we're trying to save everybody.

"We need to work on ways of identifying these people at risk, because most of them are dying at home in otherwise-unremarkable situations."

Younger Individuals, Not Necessarily Athletes

"This [study] suggests that, although less common, cardiac arrest can occur in younger-aged individuals and isn't necessarily related to organized, competitive sports," Dr Beth Abramson (St Michael's Hospital, Toronto, ON), a spokesperson for the Heart and Stroke Foundation of Canada, told heartwire.

"It speaks to the importance of ensuring that the public is trained in [cardiopulmonary resuscitation] CPR and has access to AEDs," she added.

The authors report no conflicts of interest.