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Increase of sudden cardiac deaths in Switzerland during the 2002 FIFA World Cup

2005; Elsevier BV; Volume: 107; Issue: 1 Linguagem: Inglês

10.1016/j.ijcard.2005.01.029

1874-1754

Eugène Katz, Jacques-Thierry Metzger, Alfio Marazzi, Lukas Kappenberger,

Cardiac Health and Mental Health

Acute mental stress and anger as well as alcohol abuse are known triggers of acute myocardial infarction and sudden cardiac death (SCD) [1Mittleman M.A. Maclure M. Sherwood J.B. et al.Triggering of acute myocardial infarction onset by episodes of anger. Determinants of myocardial infarction onset study investigators.Circulation. 1995; 92: 1720-1725Crossref PubMed Scopus (620) Google Scholar, 2Kauhanen J. Kaplan G.A. Goldberg D.E. Salonen J.T. Beer binging and mortality: results from the Kuopio ischaemic heart disease risk factor study, a prospective population based study.BMJ. 1997; 315: 846-851Crossref PubMed Scopus (227) Google Scholar]. An excess of SCD and increase of admissions for myocardial infarction were described during earthquakes and military conflicts [3Meisel S.R. Kutz I. Dayan K.I. et al.Effect of Iraqi missile war on incidence of acute myocardial infarction and sudden death in Israeli civilians.Lancet. 1991; 338: 660-661Abstract PubMed Scopus (353) Google Scholar, 4Leor J. Kloner R.A. The Northridge earthquake as a trigger for acute myocardial infarction.Am J Cardiol. 1996; 77: 1230-1232Abstract Full Text PDF PubMed Scopus (138) Google Scholar]. A recent publication described a 25% increase in admissions for acute myocardial infarction in Great Britain on the day England lost to Argentina during the 1998 FIFA World Cup [[5]Carroll D. Ebrahim S. Tilling K. Macleod J. Smith G.D. Admissions for myocardial infarction and World Cup football: database survey.BMJ. 2002; 325: 1439-1442Crossref PubMed Scopus (165) Google Scholar]. Our study focused on SCD, a less common event than acute myocardial infarction. We retrospectively analyzed Mobile Intensive Care Units registers during the FIFA World Cup 2002 and during the same period in 2001 in the area of 1.5 million inhabitants. Only sudden deaths of presumed cardiac origin in adults were selected for our study. Statistics were calculated using the Poisson model. Results are shown in Table 1. The major finding of this study was the 63% (p=0.02) increase of SCD during the FIFA competition. The increase of SCD was more important among males—77% (p=0.01), than among females 33% (p=0.02). We explain this by an increase in mental stress and anger and possible unhealthy behaviour (increased alcohol and tobacco consumption, decreased medical compliance) of football supporters. The lethal effect of mental stress and anger has been attributed to its activation of the sympathetic nervous system leading to hypertension, impaired myocardial perfusion in the setting of atherosclerotic disease and a high degree of cardiac electrical instability precipitating malignant arrhythmias. Even if it is impossible to prove that all victims of sudden cardiac death were football match viewers more important increase of SCD among males and the increase (however statistically non-significant) of SCD at home during the 2002 FIFA World Cup raise the likelihood of our suggestion, since males are generally more interested in football than women and usually watch football at home. Because of the time difference with South Korea and Japan, which hosted the competition, most of the football matches were transmitted in Switzerland in the early morning—the time period of the increased risk of SCD which lends weight to our hypothesis [[6]Arntz H.R. Willich S.N. Schreiber C. Bruggemann T. Stern R. Schultheiss H.P. Diurnal, weekly and seasonal variation of sudden death. Population-based analysis of 24,061 consecutive cases.Eur Heart J. 2000; 21: 315-320Crossref PubMed Scopus (306) Google Scholar].Table 1Sudden cardiac deaths during FIFA 2002 World Cup and during control periodPeriod A (31.05–30.06 2001)Period B (31.05–30.06 2002)pNumber of sudden cardiac deaths38620.02Males, N (% of total)26 (68%)46 (74%)0.01Females, N (% of total)12 (32%)16 (26%)0.02Mean (SD) age68 (26)70 (25)nsSudden cardiac death at home (%)6674nsWitnessed sudden cardiac death (%)3437nsMean (SD) call-to-shock time (min)8.2 (2.5)8.6 (2.4)nsInitial rhythm distribution:VF and VT (%)1617nsAsystole and PEA (%)8483nsPeriod A=control period; Period B=FIFA 2002 World Cup; VF=ventricular fibrillation; VT=ventricular tachycardia; PEA=pulseless electrical activity. Open table in a new tab Period A=control period; Period B=FIFA 2002 World Cup; VF=ventricular fibrillation; VT=ventricular tachycardia; PEA=pulseless electrical activity. The interpretation of our survey needs to be confirmed, although, we already advise general practitioners to inform their patients and their families about the risks of mental stress, anger and unhealthy behaviour during major sporting events. Despite short MICU response time and the fact that nearly every second SCD was witnessed, the incidence of ventricular fibrillation was low and probably due to delay in activation of the EMS system. Considering that, more information has to be provided for the general public by physicians and the media about practical measures to adopt in case of chest pain or cardiac arrest. Information about how to reach the local EMS system and how to perform cardio-pulmonary resuscitation has to be more broadly advertised before major sporting events. The reinforcement of the EMS system and development of public access defibrillation should be proposed in order to reduce the burden of SCD during major public events.