[London, UK/ Medicine] - Big gaps in basic knowledge about the numbers and causes of apparently inexplicable heart attacks among young sportsmen and women are seriously hampering our ability to prevent them, say sport and exercise medicine specialists in the British Journal of Sports Medicine . Dr Richard Weiler and colleagues say that we need to start building reliable databases of all such events across sport, in a bid to start plugging these knowledge gaps.
The comments come in the wake of the recent high profile case of premier league footballer, Fabrice Muamba, who collapsed on pitch in front of a stadium packed with spectators, after sustaining a sudden heart attack. Fortunately, he has recovered, but cases like these, although rare, are still likely to occur despite screening programmes, and they are poorly understood.
These cases have prompted improvements in pitch-side and acute sports medicine, including emergency life support, defibrillation and the development of practical education courses and emergency care guidelines. However, the authors say, “We still lack many answers to basic questions about these afflictions. We do not know the exact numbers and trends in prevalence or incidence, and do not understand the [multiple causes] that trigger sudden cardiac death in previously healthy athletes.”
Issues that still need further investigation
Issues that still need further investigation are the roles of gender and ethnicity, geography and genes. For example, Sub-Saharan Africa may be a ′cardiac hotspot′, with recent research linking sudden heart attacks to sickle cell trait. Other research suggests that African Americans are three times more prone to sudden cardiac death/arrest than white athletes, although the rates vary considerably depending on the type of sport played.
Screening programmes throw up a considerable number of false positive results, and it is still far from clear whether screening actually cuts the number of deaths, whether it is cost effective, and how to manage any abnormal findings. In football, FIFA has made the precompetition medical assessment for all FIFA competitions mandatory and recently initiated the establishment of a database for SCA/SCD for all 208 Member Associations to obtain more information.
“It is vital that we start to answer these questions based on reliable science and evidence. To achieve this, we propose the collection and recording of reliable data across sport of every sudden cardiac death/arrest,” they added. But for this to happen in all sports, they say, co-operation and collaboration will be needed among sporting organisations, federations, and clubs, in addition to the establishment of sport-specific and national registries for these incidents. [hw][Photo: BWFC show of support for Fabrice Muamba vs Blackburn Rovers on 24th March 2012/ Photo credit: Matthew Chadwick]
Weiler R, Goldstein MA, Beasley I , Drezner J, Dvorak J. What can we do to reduce the number of tragic cardiac events in sport? British Journal of Sports Medicine. Online First, published on May 6, 2012. doi 10.1136/bjsports-2012-091252