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Sudden cardiac arrest in exercising older adults not related to disease burden

1st February 2023

The incidence of sudden cardiac arrest (SCA) among older adults during sporting activities is low and not related to either co-morbidities or cardiovascular risk factors in comparison to non-exercising sudden arrests according to the findings of a prospective study by US researchers.

Sudden cardiac death is due to a cardiovascular cause and occurs within one hour of symptom onset. While possible triggers include factors such as vigorous exercise, interestingly, habitual vigorous exercise appears to reduce the risk of such deaths.

In other work focusing on middle-aged people engaging in sporting activities, it was has found that the level of sudden cardiac arrests is relatively low illustrating the high-benefit, low-risk of sporting activities in such individuals.

However, there is lack of studies examining the incidence of SCA among older adults who participate in sporting activities.

In the current study, researchers turned to two large prospective US studies to more closely examine the incidence of SCA among adults 65 years of age and older.

They identified information on the presence of any potential warning signs prior to the arrest, the circumstances under which the arrest occurred and collected detailed information on the patient’s clinical history.

They defined a SCA as occurring either during or within one hour of stopping a sporting activity and compared the incidence to sudden arrests that occurred among older adults but who were not exercising.

Sudden cardiac arrest during sporting activity

Data were available for 1.85 million individuals and there were a total of 4,078 SCAs among those aged 65 and older (1.9%) and of these, 77 occurred during exercise, with 91% of cases in men, mainly during cycling, gym activity and running.

When comparing SCAs among those who exercised to non-exercising controls, individuals whose arrest happened while exercising had a significantly lower burden of cardiovascular risk factors such as hypertension (e.g., 57.8% vs 80.1%), diabetes or obesity (p = 0.03) and co-morbidities such as asthma or COPD (p < 0.005).

Interestingly, only 26% of those with a SCA during exercise had prior warning signs, mainly chest pain (55%) in the 24 hours before the arrest. Moreover, survival was higher among the exercise group compared to the non-exercising group (43.8% vs 11.1%).

The authors concluded that the risk of a sudden cardiac arrest was uncommon among older adults and probably outweighed by the benefits of exercise.

Holmstrom L et al. Sudden Cardiac Arrest During Sports Activity in Older Adults. JACC Clin. Electrophysiol 2023.