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Edwards JJ, Compton C, Chatrath N, Petek BJ, Baggish A, Börjesson M, Chung E, Corrado D, Drezner JA, Gati S, Gray B, Kim J, La Gerche A, Malhotra A, Marijon E, Papadakis M, Pelliccia A, Phelan D, Semsarian C, Sharma S, Sharma R, O'Driscoll JM, Harmon KG. International Criteria for Reporting Study Quality for Sudden Cardiac Arrest/Death Tool. J Am Heart Assoc 2024; 13:e033723. [PMID: 38780180 DOI: 10.1161/jaha.123.033723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 04/15/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND Studies reporting on the incidence of sudden cardiac arrest and/or death (SCA/D) in athletes commonly lack methodological and reporting rigor, which has implications for screening and preventative policy in sport. To date, there are no tools designed for assessing study quality in studies investigating the incidence of SCA/D in athletes. METHODS AND RESULTS The International Criteria for Reporting Study Quality for Sudden Cardiac Arrest/Death tool (IQ-SCA/D) was developed following a Delphi process. Sixteen international experts in sports cardiology were identified and invited. Experts voted on each domain with subsequent moderated discussion for successive rounds until consensus was reached for a final tool. Interobserver agreement between a novice, intermediate, and expert observer was then assessed from the scoring of 22 relevant studies using weighted and unweighted κ analyses. The final IQ-SCA/D tool comprises 8 domains with a summated score of a possible 22. Studies are categorized as low, intermediate, and high quality with summated IQ-SCA/D scores of ≤11, 12 to 16, and ≥17, respectively. Interrater agreement was "substantial" between all 3 observers for summated IQ-SCA/D scores and study categorization. CONCLUSIONS The IQ-SCA/D is an expert consensus tool for assessing the study quality of research reporting the incidence of SCA/D in athletes. This tool may be used to assist researchers, reviewers, journal editors, and readers in contextualizing the methodological quality of different studies with varying athlete SCA/D incidence estimates. Importantly, the IQ-SCA/D also provides an expert-informed framework to support and guide appropriate design and reporting practices in future SCA/D incidence trials.
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Affiliation(s)
- Jamie J Edwards
- School of Psychology and Life Sciences Canterbury Christ Church University Kent UK
| | - Claire Compton
- Department of Cardiology South Tees Hospitals National Health Service Foundation Trust, The James Cook University Hospital Middlesbrough UK
| | - Nikhil Chatrath
- Cardiology Clinical Academic Group, St George's University of London London UK
| | - Bradley J Petek
- Division of Cardiology Massachusetts General Hospital Boston MA
| | - Aaron Baggish
- Cardiovascular Performance Program Massachusetts General Hospital Boston MA
| | - Mats Börjesson
- Center for Lifestyle Intervention, Medicine, Geriatrics and Emergency Department Sahlgrenska University Hospital Göteborg Sweden
- Department of Molecular and Clinical Medicine Institute of Medicine, Sahlgrenska Academy, University of Gothenburg Göteborg Sweden
| | - Eugene Chung
- University of Michigan, West Michigan Program, Cardiac Electrophysiology Service, Sports Cardiology Clinic, Michigan Medicine Ann Arbor MI
| | - Domenico Corrado
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health University of Padova Padova Italy
| | - Jonathan A Drezner
- Department of Family Medicine, Center for Sports Cardiology University of Washington Seattle WA
| | - Sabiha Gati
- National Heart and Lung Institute, Imperial College London London UK
- Department of Cardiology Royal Brompton Hospital London London UK
| | - Belinda Gray
- Agnes Ginges Centre for Molecular Cardiology Centenary Institute New South Wales Australia
- Faculty of Health and Medical Sciences University of Sydney New South Wales Australia
- Department of Cardiology Royal Prince Alfred Hospital New South Wales Australia
| | - Jonathan Kim
- Emory School of Medicine Emory Clinical Cardiovascular Research Institute Atlanta GA
| | - Andre La Gerche
- Clinical Research Domain Baker Heart and Diabetes Institute, Alfred Centre Melbourne Victoria Australia
- National Centre for Sports Cardiology Fitzroy Victoria Australia
- Cardiology Department St Vincent's Hospital Melbourne Fitzroy Victoria Australia
| | - Aneil Malhotra
- Cardiology Clinical Academic Group, St George's University of London London UK
- Institute of Sport Manchester Metropolitan University and Manchester University NHS Foundation Trust Manchester UK
| | - Eloi Marijon
- Paris Cardiovascular Research Center INSERM U970, Hôpital Européen Georges Pompidou Paris France
| | - Michael Papadakis
- Cardiology Clinical Academic Group, St George's University of London London UK
| | | | - Dermot Phelan
- Sports Cardiology Center, Sanger Heart and Vascular Institute, Atrium Health Charlotte NC
| | - Chris Semsarian
- Agnes Ginges Centre for Molecular Cardiology Centenary Institute New South Wales Australia
- Faculty of Health and Medical Sciences University of Sydney New South Wales Australia
- Department of Cardiology Royal Prince Alfred Hospital New South Wales Australia
| | - Sanjay Sharma
- Cardiology Clinical Academic Group, St George's University of London London UK
| | - Rajan Sharma
- Department of Cardiology St George's University Hospitals NHS Foundation Trust Tooting, London UK
| | - Jamie M O'Driscoll
- School of Psychology and Life Sciences Canterbury Christ Church University Kent UK
- Department of Cardiology St George's University Hospitals NHS Foundation Trust Tooting, London UK
| | - Kimberly G Harmon
- Department of Family Medicine, Center for Sports Cardiology University of Washington Seattle WA
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McKinney J, Isserow M, Wong J, Isserow S, Moulson N. New Insights and Recommendations for Athletes With Hypertrophic Cardiomyopathy. Can J Cardiol 2024; 40:921-933. [PMID: 38369259 DOI: 10.1016/j.cjca.2024.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 02/13/2024] [Accepted: 02/14/2024] [Indexed: 02/20/2024] Open
Abstract
Hypertrophic cardiomyopathy (HCM) has long been considered to be a high-risk cardiac condition for which exercise was thought to increase the risk of sudden cardiac death (SCD). This was founded in part by initial autopsy studies reporting HCM to be a leading medical cause of SCD among young athletes. Most forms of competitive sport and exercise were therefore thought to increase the risk of SCD to a prohibitive level. Resultant expert consensus guideline recommendations universally restricted athletes with HCM from participation in moderate- to vigourous-intensity sport and exercise in a binary "yes" or "no" clinical decision making process with the goal of reducing the risk of sports-related SCD. HCM is, however, a heterogeneous genetic condition with variable penetrance and risk. The degree to which sports and exercise increases the risk of SCD at an individual patient level continues to be an area of clinical uncertainty. Emerging data and clinical experience from the past several decades have provided important new insights into exercise-related risks and have brought into question the appropriateness of overly restrictive binary clinical decision making for exercise recommendations in HCM. This includes an improved understanding of the overall prevalence of HCM in the general population, improved observational estimates of the risk of SCD related to continued sport and exercise participation, and a general shift toward improved patient-centred approaches to care through shared decision making processes. The rules by which the game is played may be changing for athletes with HCM.
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Affiliation(s)
- James McKinney
- SportsCardiologyBC, University of British Columbia, Vancouver, British Columbia, Canada; Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Megan Isserow
- SportsCardiologyBC, University of British Columbia, Vancouver, British Columbia, Canada
| | - Justin Wong
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Saul Isserow
- SportsCardiologyBC, University of British Columbia, Vancouver, British Columbia, Canada; Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Nathaniel Moulson
- SportsCardiologyBC, University of British Columbia, Vancouver, British Columbia, Canada; Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
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Boden BP, Anderson SA, Sheehan FT. Catastrophic Sports Injuries: Causation and Prevention. J Bone Joint Surg Am 2024; 106:62-73. [PMID: 37988459 DOI: 10.2106/jbjs.23.00335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2023]
Abstract
➤ Catastrophic injuries in U.S. high school and college athletes are rare but devastating injuries.➤ Catastrophic sports injuries are classified as either traumatic, caused by direct contact during sports participation, or nontraumatic, associated with exertion while participating in a sport.➤ Football is associated with the greatest number of traumatic and nontraumatic catastrophic injuries for male athletes, whereas cheerleading has the highest number of traumatic catastrophic injuries and basketball has the highest number of nontraumatic catastrophic injuries for female athletes.➤ The incidence of traumatic catastrophic injuries for all sports has declined over the past 40 years, due to effective rule changes, especially in football, pole-vaulting, cheerleading, ice hockey, and rugby. Further research is necessary to reduce the incidence of structural brain injury in contact sports such as football.➤ The incidence of nontraumatic catastrophic injuries has increased over the last 40 years and requires additional research and preventive measures. Avoiding overexertion during training, confirming sickle cell trait status in high school athletes during the preparticipation physical examination, and developing cost-effective screening tools for cardiac abnormalities are critical next steps.
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Affiliation(s)
- Barry P Boden
- The Orthopaedic Center, The Centers for Advanced Orthopaedics, Rockville, Maryland
- Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | | | - Frances T Sheehan
- Department of Rehabilitation Medicine, National Institutes of Health, Bethesda, Maryland
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4
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Sun Y. CHARACTERISTICS OF MAJOR SPORTS INJURIES IN HIGH-PERFORMANCE ATHLETES. REV BRAS MED ESPORTE 2023. [DOI: 10.1590/1517-8692202329012022_0189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
ABSTRACT Introduction The focus of attention in high-performance athlete injuries tends to be on physical recovery, neglecting psychological factors and their practical social impacts on the rehabilitation of the injured athlete. In this phase, giving attention to the importance of athletes’ thoughts, emotions, and motivation can speed up the biopsychosocial rehabilitation process. Objective To analyze the characteristics involved in the major sports injuries of high-level athletes to provide a reference for athletes and coaches during recovery. Methods This article analyzes through bibliographic research the characteristics of the major sports injuries in high-level athletes, including physiological, psychological, and social factors. Results The physical impact of injuries requires patience and persistence for recovery, including additional muscle strengthening to compensate for the loss of residual joint proprioception, ensuring performance recovery. Mental factors such as insecurity when returning from games, reduced self-confidence, and fear of hurting the team must be worked through in parallel in multi-professional care and during long recovery periods. Conclusion Sports injuries can occur in athletes of all levels. For elite athletes, the impact of injuries, especially severe ones that need to interrupt training or even surgery, will lead to forced suspension of training or competition, preventing the improvement of sports performance, decreasing the quality of the sports career, and may even lead to physical or psychological disability in severe cases. Level of evidence II; Therapeutic studies - investigation of treatment outcomes.
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Affiliation(s)
- Yu’an Sun
- Chengdu University of Traditional Chinese Medicine, China
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Bassi MD, Farina JM, Bombau J, Fitz Maurice M, Bortman G, Nuñez E, Márquez M, Bornancini N, Baranchuk A. Sudden Cardiac Arrest in Basketball and Soccer Stadiums, the Role of Automated External Defibrillators: A Review. For the BELTRAN Study (BaskEtbaLl and soccer sTadiums: Registry on Automatic exterNal defibrillators). Arrhythm Electrophysiol Rev 2023; 12:e03. [PMID: 36845166 PMCID: PMC9945480 DOI: 10.15420/aer.2022.30] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 11/29/2022] [Indexed: 02/03/2023] Open
Abstract
Sudden cardiac arrest (SCA) during sports events has a dramatic impact on stadium-goers and the public and is often associated with poor outcomes unless treated with an automated external defibrillator (AED). Despite this, stadiums vary in AED use. This review aims to identify the risks and incidences of SCA, and the use of AEDs in soccer and basketball stadiums. A narrative review of all relevant papers was conducted. Athletes across all sports face an SCA risk of 1:50,000 athlete-years, with the greatest risk of SCA in young male athletes (1:35,000 person-years) and black male athletes (1:18,000 person-years). Africa and South America have the poorest soccer SCA outcomes at 3% and 4% survival. AED use on-site improves survival greater than defibrillation by emergency services. Many stadiums do not have AEDs implemented into medical plans and the AEDs are often unrecognisable or are obstructed. Therefore, AEDs should be used on-site, use clear signalling, have certified trained personnel, and be incorporated into stadiums' medical plans.
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Affiliation(s)
- Mario D. Bassi
- Department of Medicine, Kingston Health Science Centre, Queen’s University, Kingston, Ontario, Canada
| | - Juan M. Farina
- Department of Cardiovascular and Thoracic Surgery, Mayo Clinic, Phoenix, Arizona, US
| | - Jorge Bombau
- Internal Medicine, National University of La Plata, Argentina
| | - Mario Fitz Maurice
- Department of Cardiology, Hospital de Agudos Bernardino Rivadavia, Buenos Aires, Argentina
| | | | - Elaine Nuñez
- Servicio de Cardiología, Cedimat Centro Cardiovascular, Santo Domingo, República Dominicana
| | - Manlio Márquez
- Department of Electrophysiology, Centro Médico ABC (American British Cowdray), Ciudad de México, México
| | - Norberto Bornancini
- Department of Cardiology, Hospital General de Agudos “General Manuel Belgrano”, Buenos Aires, Argentina
| | - Adrian Baranchuk
- Department of Medicine, Kingston Health Science Centre, Queen’s University, Kingston, Ontario, Canada,Division of Cardiology, Queen’s University, Kingston, Ontario, Canada
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Valenzuela PL, Baggish A, Castillo-García A, Santos-Lozano A, Boraita A, Lucia A. Strenuous Endurance Exercise and the Heart: Physiological versus Pathological Adaptations. Compr Physiol 2022; 12:4067-4085. [PMID: 35950659 DOI: 10.1002/cphy.c210045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Although the benefits of regular physical activity on cardiovascular health are well established, the effects of strenuous endurance exercise (SEE) have been a matter of debate since ancient times. In this article, we aim to provide a balanced overview of what is known about SEE and the heart-from epidemiological evidence to recent cardiac imaging findings. Lifelong SEE is overall cardioprotective, with endurance master athletes showing in fact a youthful heart. Yet, some lines of research remain open, such as the need to elucidate the time-course and potential relevance of transient declines in heart function (or increases in biomarkers of cardiac injury) with SEE. The underlying mechanisms and clinical relevance of SEE-associated atrial fibrillation, myocardial fibrosis, or high coronary artery calcium scores also remain to be elucidated. © 2022 American Physiological Society. Compr Physiol 12:1-19, 2022.
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Affiliation(s)
- Pedro L Valenzuela
- Physical Activity and Health Research Group ('PaHerg'), Research Institute of the Hospital 12 de Octubre ('imas12'), Madrid, Spain
| | - Aaron Baggish
- Cardiovascular Performance Program, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Adrián Castillo-García
- Fissac - Physiology, Health and Physical Activity, Madrid, Spain.,Biology Systems Department, University of Alcalá, Madrid, Spain
| | - Alejandro Santos-Lozano
- Physical Activity and Health Research Group ('PaHerg'), Research Institute of the Hospital 12 de Octubre ('imas12'), Madrid, Spain.,i+HeALTH, European University Miguel de Cervantes, Valladolid, Spain
| | - Araceli Boraita
- Department of Cardiology, Sports Medicine Center, Spanish Agency for Health Protection in Sports, Madrid, Spain
| | - Alejandro Lucia
- Physical Activity and Health Research Group ('PaHerg'), Research Institute of the Hospital 12 de Octubre ('imas12'), Madrid, Spain.,Faculty of Sport Sciences, Universidad Europea de Madrid, Madrid, Spain
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Swaffield TP, Olympia RP. School Nurses on the Front Lines of Healthcare: Emergencies Associated With Sport and Physical Activities (Part 2): Sudden Cardiac Arrest, Hypovolemic Shock, and Spinal Cord Injury. NASN Sch Nurse 2021; 37:141-146. [PMID: 34743625 DOI: 10.1177/1942602x211046048] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Sport participation is an important part of the development, both physically and mentally, of children and adolescents in the United States. Illness and injury associated with sport and physical activities may occur in the school setting. Although most sport-related illness and injury in students are considered minor emergencies, life-threatening illnesses or injuries may occur. It is important for the school nurse to recognize potential life-threatening emergencies associated with sport and physical activity, to initiate stabilization of the student with life-threatening symptoms, and to triage these students to an appropriate level of care (back to the classroom, home with their guardian with follow up at their primary healthcare provider's office, or directly to the closest emergency department via Emergency Medical Services). This article specifically describes the initial assessment and management of three potentially life-threatening conditions associated with sport and physical activity, namely sudden cardiac arrest, hypovolemic shock, and spinal cord injury.
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Affiliation(s)
- Thomas P Swaffield
- General Pediatrics Resident Physician Penn State Hershey Children's Hospital Hershey, PA
| | - Robert P Olympia
- Professor, Departments of Emergency Medicine and Pediatrics, Penn State College of Medicine, Attending Pediatric Emergency Medicine Physician, Penn State Hershey Medical Center Hershey, PA
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Lear A, Patel N, Mullen C, Simonson M, Leone V, Koshiaris C, Nunan D. Screening electrocardiogram in young athletes and military members: a systematic review and meta-analysis. J Athl Train 2021; 57:444-451. [PMID: 34038955 PMCID: PMC9205557 DOI: 10.4085/1062-6050-0746.20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To determine the effect of electrocardiogram (ECG) screening on prevention of sudden cardiac arrest and death (SCA/D) in young athletes and military members. DATA SOURCES MEDLINE, Embase, Cochrane CENTRAL, Web of Science, BIOSIS, Scopus, SPORT discus, PEDro, and clinicaltrials.gov were searched from inception to dates between 2/21/19 and 7/29/19. STUDY SELECTION Randomized and non-randomized controlled trials, where pre-participation examination including ECG was the primary intervention used to screen athletes or military 40 years of age or younger. Accepted controls were no screening, usual care, or pre-participation examination without ECG. 3 published studies , and one conference abstract were identified for inclusion. DATA EXTRACTION In all four studies, risk of bias was assessed with the Cochrane risk of bias tool, and found to be generally high. Two studies had data extracted for random effects meta-analysis, and the remaining study and conference abstract were included in narrative review. Overall quality of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) Data Synthesis: Four non-randomized studies (11,689,172 participants) were included, all at high risk of bias. Pooled data from two studies (n= 3,869,274; very low quality evidence) observed an inconclusive 42% relative decrease in risk of sudden cardiac death (RR 0.58; 95% CI 0.23, 1.45), equating to an absolute risk reduction of .0016% The findings were consistent with a potential 67% relative decrease to a 45% relative increased risk in participants screened with ECG. Heterogeneity was found to be high as measured with I2 statistic (71%). Data from the remaining study and abstract were similarly inconclusive. CONCLUSION Existing evidence for the effect of ECG screening is inconclusive and of very low quality. Our meta-analysis observed that screening ECG may result in considerable benefit or harm to participants. Higher quality studies are needed to reduce this uncertainty. PROSPERO Registration: CRD42019125560.
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Affiliation(s)
- Aaron Lear
- Cleveland Clinic Akron General, Akron, OH USA
| | | | | | | | - Vince Leone
- Northeast Ohio Medical University (NEOMED), Akron, OH USA
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