Decline of Sudden Cardiac Deaths in Athletes Who Screen
Sudden cardiac deaths in athletes
The annual incidence of sudden cardiovascular deaths among young athletes has declined significantly since the start of a pre-participation cardiovascular screening program in northeast Italy, according to a study in the October 4 issue of JAMA.
The majority of young athletes who die suddenly have previously unsuspected structural heart disease. Medical evaluation of athletes before competition offers the potential to identify those without symptoms of potentially deadly cardiovascular abnormalities. Italian law mandates that prior to participating in competitive sports activity, every athlete must undergo a clinical evaluation and obtain eligibility, according to background information in the article. A nationwide systematic screening program was launched in Italy in 1982, which includes a detailed history, physical examination, and an electrocardiogram (ECG); the program has been shown to be effective in identifying athletes with certain heart disorders. However, the long-term impact of such a screening program on prevention of sudden cardiovascular death in athletes has not been known.
Domenico Corrado, M.D., Ph.D., of the University of Padua Medical School, Italy and colleagues analyzed the changes in incidence rates and causes of sudden cardiovascular death in young athletes (age 12 to 35 years) in the Veneto region of Italy between 1979 and 2004, after introduction of systematic pre-participation screening. A parallel study examined trends in cardiovascular causes of disqualification from competitive sports in 42,386 athletes undergoing pre-participation screening at the Center for Sports Medicine in Padua (22,312 in the early screening period [1982-1992] and 20,074 in the late screening period [1993-2004]).
During the study period, 55 sudden cardiovascular deaths occurred in screened athletes (1.9 deaths/100,000 person-years) and 265 sudden deaths in unscreened nonathletes (0.79 deaths/100,000 person-years). Person-years is the number of people in the study times the number of years of follow-up per person. The annual incidence of sudden cardiovascular death in athletes decreased by 89 percent, from 3.6/100,000 person-years in 1979-1980 to 0.4/100,000 person-years in 2003-2004; the incidence of sudden death among the unscreened nonathletic population did not change significantly over that time.
The decline in the death rate started after mandatory screening was started and persisted to the late screening period. Compared with the pre-screening period (1979