Abstract
Background and objectives: An Italian nationwide pre-participation screening approach for prevention of sudden cardiac death in athletes (SCD-A) in competitive sportspeople showed promising results but did not achieve international consensus, due to cost-effectiveness and the shortfall of a monitoring plan. From this perspective, we tried to provide an epidemiological update of SCD-A in Italy through a year-long internet-based search. Materials and Methods: One year-long Google search was performed using mandatory and non-mandatory keywords. Data were collected according to prevalent SCD-A definition and matched with sport-related figures from Italian National Institute of Statistics (ISTAT) and Italian National Olympic Committee (CONI). Results: Ninety-eight cases of SCD-A in 2019 were identified (48.0% competitive, 52.0% non-competitive athletes). Male/female ratio was 13:1. The most common sports were soccer (33.7%), athletics (15.3%) and fitness (13.3%). A conclusive diagnosis was achieved only in 37 cases (33 of cardiac origin), with the leading diagnosis being coronary artery disease in 27 and a notably higher occurrence among master athletes. Combining these findings with ISTAT and CONI data, the SCD-A incidence rate in the whole Italian sport population was found to be 0.47/100,000 persons per year (1.00/100,000 in the competitive and 0.32/100,000 in the non-competitive population). The relative risk of SCD-A is 3.1 (CI 2.1–4.7; p < 0.0001) for competitive compared to non-competitive athletes; 9.9 for male (CI 4.6–21.4; p < 0.0001) with respect to female. Conclusions: We provided an updated incidence rate of SCD-A in both competitive and non-competitive sport in Italy. A higher risk of SCD-A among competitive and male athletes was confirmed, thus corroborating the value of Italian pre-participation screening in this population.
Highlights
Sudden cardiac death in athletes (SCD-A) is commonly defined as a death occurring within one hour of initial acute symptoms due to cardiovascular collapse among sport practitioners in the absence of external causal factors [1].This definition excludes deaths related to traumas, technical errors and use of drugs
Analyzing the young athletic population, estimated by Institute of Statistics (ISTAT) in about 14 million 874 thousand people, we found 37 occurrences in our series, with an incidence rate of sudden cardiac death in athletes (SCD-A) of 0.25 in 100,000 persons per year: these figures are 4 times lower than incidence rate determined by Corrado et al, but they match with data from Marjion et al (0.22/100,000) [2] and Risgaard et al (0.43/100,000) [8]
Data from Italian National Olympic Committee (CONI) monitoring, through the total number of competitive athletes engaged in every sport, allowed us to estimate the incidence of SCD-A per every competitive sport: from this perspective, we found the highest incidence of SCD-A in hockey (18.2/100,000), motorsports (9.5/100,000), athletics
Summary
Sudden cardiac death in athletes (SCD-A) is commonly defined as a death occurring within one hour of initial acute symptoms due to cardiovascular collapse (or within 24 h in unwitnessed cases) among sport practitioners in the absence of external causal factors [1]. This definition excludes deaths related to traumas, technical errors and use of drugs (doping included). To 6.8/100,000 among UK-based adolescent soccer players [7], to 6.64/100,000 among competitive athletes between 35 and 49 years old [8] This brings broad controversies about the best approach to prevent SCD-A [9]. Corrado et al in 2006 showed a clear decrease of incidence of SCD-A since the introduction of this systematic pre-participation screening [11]
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