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Prevention of sudden death in apparently healthy athletes, where do we stand Switzerland?


Capelli, Bruno; Regol, F (2016). Prevention of sudden death in apparently healthy athletes, where do we stand Switzerland? Cardiovascular Medicine, 19(2):44-51.

Abstract

Sudden cardiac death (SCD) during sport is frequently the first and the last manifestation of an unrecognised, underlying, often asymptomatic heart disease. Athletes are seen as one of the healthiest segments of the population. SCD in an athlete is always shocking and profoundly affects the communities where it occurs. As a result of the considerable media attention that often accompanies SCD in an athlete, it has been suggested that its prevalence is overestimated. However, in reality the incidence may still be higher than we think as SCD events occurring during recreational-leisure sports may be underreported. An overall incidence of 1:50 000 athletes per year is a reasonable estimate based on available retrospective cohort studies and prospective observational or cross-sectional studies with male black basketball athletes being at higher risk (1:11 000 athletes per year). Overall the health benefits of regular exercise heavily outweigh the risks of SCD in young and in older athletes, especially in those who train appropriately. This is “the paradox of sports”: physicians are faced with the challenge of providing a sensible strategy for the prevention of SCD while simultaneously reaffirming that the benefits of regular exercise far outweigh potential risks. Considering the potentially increased, albeit small, risk of cardiac events and SCD during physical activity (PA), it is prudent to establish practical and pragmatic algorithms for the cardiovascular evaluation of young and of middle-aged / senior individuals before engaging in regular PA. However, there is disagreement on how to implement an effective pre-participation screening strategy of SCD prevention in athletes, which is, at the same time, cost-effective. At present there is a broad range of screening recommendations, which vary from country to country. In this brief review, we summarise the current state of knowledge in this area with respect to epidemiology, mechanisms, approaches to risk stratification based on existing scientific evidence and on expert documents. Screening for SCD prevention in athletes by cardiology/sport physicians in Switzerland will then be discussed.

Abstract

Sudden cardiac death (SCD) during sport is frequently the first and the last manifestation of an unrecognised, underlying, often asymptomatic heart disease. Athletes are seen as one of the healthiest segments of the population. SCD in an athlete is always shocking and profoundly affects the communities where it occurs. As a result of the considerable media attention that often accompanies SCD in an athlete, it has been suggested that its prevalence is overestimated. However, in reality the incidence may still be higher than we think as SCD events occurring during recreational-leisure sports may be underreported. An overall incidence of 1:50 000 athletes per year is a reasonable estimate based on available retrospective cohort studies and prospective observational or cross-sectional studies with male black basketball athletes being at higher risk (1:11 000 athletes per year). Overall the health benefits of regular exercise heavily outweigh the risks of SCD in young and in older athletes, especially in those who train appropriately. This is “the paradox of sports”: physicians are faced with the challenge of providing a sensible strategy for the prevention of SCD while simultaneously reaffirming that the benefits of regular exercise far outweigh potential risks. Considering the potentially increased, albeit small, risk of cardiac events and SCD during physical activity (PA), it is prudent to establish practical and pragmatic algorithms for the cardiovascular evaluation of young and of middle-aged / senior individuals before engaging in regular PA. However, there is disagreement on how to implement an effective pre-participation screening strategy of SCD prevention in athletes, which is, at the same time, cost-effective. At present there is a broad range of screening recommendations, which vary from country to country. In this brief review, we summarise the current state of knowledge in this area with respect to epidemiology, mechanisms, approaches to risk stratification based on existing scientific evidence and on expert documents. Screening for SCD prevention in athletes by cardiology/sport physicians in Switzerland will then be discussed.

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Additional indexing

Item Type:Journal Article, refereed, further contribution
Communities & Collections:04 Faculty of Medicine > Cardiocentro Ticino
Dewey Decimal Classification:610 Medicine & health
Language:English
Date:2016
Deposited On:30 Jan 2017 08:16
Last Modified:30 Jan 2017 08:16
Publisher:EMH Swiss Medical Publishers
ISSN:1423-5528
Free access at:Publisher DOI. An embargo period may apply.
Publisher DOI:https://doi.org/10.4414/cvm.2016.00391

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