Sudden Cardiac Death in Athletes in Italy during 2019: Internet-Based Epidemiological Research

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.

Epidemiology of Football-Related Sudden Cardiac Death in Turkey

“…In the present study, football-related age-specific mortality was found to be 0.41 per 100,000 population and proportional mortality was 0.30 per 1000 deaths. This compares favorably with previously published studies identifying mortality rates of 0.9 in physically active men aged 15-34 years in Norway [26], but is higher than studies of sudden cardiac death among athletes in Italy (0.28) [21]. When compared to published rates of footballrelated sudden cardiac death, our finding (0.41) is lower [3,27].…”

“…The incidence of sudden cardiac death in athletes indicates controversial results, largely due to the fact that studies attempt to determine the incidence of sudden cardiac death using different calculations [28]. Football-related sudden cardiac death, though rare, is a problem that requires attention [21].…”

“…Due to a lack of official data at a national level, all data presented in this study were identified from media reports. This is an accepted approach and has been used previously to determine the incidence of sudden cardiac death in athletes [10,[19][20][21]. However, it must be noted that inclusion of cases within this study rely on the media reporting cardiac involvement, as opposed to a sudden (unexplained) death of other causes.…”

“…Although autopsy-based studies have previously conducted in Turkey, they are limited to small sample sizes (n = 6 and n = 15) [17,18] as not all fatalities have confirmed causes of death by autopsy [17]. For this reason, data derived from media reports can be a viable alternative, as has been seen in other studies [10,[19][20][21].…”

“…There are limitations associated with this research. Cases included in this study are sudden deaths deemed to be of cardiac origin from media reports only and may not be as accurate as case reports based on findings from an autopsy [21], or may be sudden deaths of unexplained causes. However, although media data may not capture all deaths, it should be noted that this method identifies more cases than autopsy-based or case studies.…”