Original Research
19 September 2017

Death and Cardiac Arrest in U.S. Triathlon Participants, 1985 to 2016: A Case Series

Publication: Annals of Internal Medicine
Volume 167, Number 8

Abstract

Background:

Reports of race-related triathlon fatalities have raised questions regarding athlete safety.

Objective:

To describe death and cardiac arrest among triathlon participants.

Design:

Case series.

Setting:

United States.

Participants:

Participants in U.S. triathlon races from 1985 to 2016.

Measurements:

Data on deaths and cardiac arrests were assembled from such sources as the U.S. National Registry of Sudden Death in Athletes (which uses news media, Internet searches, LexisNexis archival databases, and news clipping services) and USA Triathlon (USAT) records. Incidence of death or cardiac arrest in USAT-sanctioned races from 2006 to 2016 was calculated.

Results:

A total of 135 sudden deaths, resuscitated cardiac arrests, and trauma-related deaths were compiled; mean (±SE) age of victims was 46.7 ± 12.4 years, and 85% were male. Most sudden deaths and cardiac arrests occurred in the swim segment (n = 90); the others occurred during bicycling (n = 7), running (n = 15), and postrace recovery (n = 8). Fifteen trauma-related deaths occurred during the bike segment. Incidence of death or cardiac arrest among USAT participants (n = 4 776 443) was 1.74 per 100 000 (2.40 in men and 0.74 in women per 100 000; P < 0.001). In men, risk increased substantially with age and was much greater for those aged 60 years and older (18.6 per 100 000 participants). Death or cardiac arrest risk was similar for short, intermediate, and long races (1.61 vs. 1.41 vs. 1.92 per 100 000 participants). At autopsy, 27 of 61 decedents (44%) had clinically relevant cardiovascular abnormalities, most frequently atherosclerotic coronary disease or cardiomyopathy.

Limitations:

Case identification may be incomplete and may underestimate events, particularly in the early study period. In addition, prerace medical history is unknown in most cases.

Conclusion:

Deaths and cardiac arrests during the triathlon are not rare; most have occurred in middle-aged and older men. Most sudden deaths in triathletes happened during the swim segment, and clinically silent cardiovascular disease was present in an unexpected proportion of decedents.

Primary Funding Source:

Minneapolis Heart Institute Foundation.

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Supplemental Material

Supplement. Study Protocol

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Information & Authors

Information

Published In

cover image Annals of Internal Medicine
Annals of Internal Medicine
Volume 167Number 817 October 2017
Pages: 529 - 535

History

Published online: 19 September 2017
Published in issue: 17 October 2017

Keywords

Authors

Affiliations

Kevin M. Harris, MD
From Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, Minneapolis, Minnesota; University of Mississippi Medical Center, Jackson, Mississippi; and Tufts Medical Center, Boston, Massachusetts.
Lawrence L. Creswell, MD
From Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, Minneapolis, Minnesota; University of Mississippi Medical Center, Jackson, Mississippi; and Tufts Medical Center, Boston, Massachusetts.
Tammy S. Haas, RN
From Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, Minneapolis, Minnesota; University of Mississippi Medical Center, Jackson, Mississippi; and Tufts Medical Center, Boston, Massachusetts.
Taylor Thomas, BS
From Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, Minneapolis, Minnesota; University of Mississippi Medical Center, Jackson, Mississippi; and Tufts Medical Center, Boston, Massachusetts.
Monica Tung, BA
From Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, Minneapolis, Minnesota; University of Mississippi Medical Center, Jackson, Mississippi; and Tufts Medical Center, Boston, Massachusetts.
Erin Isaacson, BS
From Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, Minneapolis, Minnesota; University of Mississippi Medical Center, Jackson, Mississippi; and Tufts Medical Center, Boston, Massachusetts.
Ross F. Garberich, MS
From Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, Minneapolis, Minnesota; University of Mississippi Medical Center, Jackson, Mississippi; and Tufts Medical Center, Boston, Massachusetts.
Barry J. Maron, MD
From Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, Minneapolis, Minnesota; University of Mississippi Medical Center, Jackson, Mississippi; and Tufts Medical Center, Boston, Massachusetts.
Acknowledgment: The authors acknowledge the substantial help of USAT in providing data for this investigation.
Financial Support: By the Minneapolis Heart Institute Foundation.
Disclosures: Dr. Creswell reports personal fees from USA Triathlon outside the submitted work and has been an annual member, a medical review panel member, and a committee member of USA Triathlon. Authors not named here have disclosed no conflicts of interest. Disclosures can also be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M17-0847.
Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that she has no financial relationships or interests to disclose. Darren B. Taichman, MD, PhD, Executive Deputy Editor, reports that he has no financial relationships or interests to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Deborah Cotton, MD, MPH, Deputy Editor, reports that she has no financial relationships or interest to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Catharine B. Stack, PhD, MS, Deputy Editor for Statistics, reports that she has stock holdings in Pfizer and Johnson & Johnson.
Reproducible Research Statement: Study protocol: See the Supplement. Statistical code: Not applicable. Data set: Not available.
Corresponding Author: Kevin M. Harris, MD, Minneapolis Heart Institute at Abbott Northwestern Hospital, 920 East 28th Street, Suite 300, Minneapolis, MN 55407; e-mail, [email protected].
Current Author Addresses: Dr. Harris, Ms. Haas, and Mr. Garberich: Minneapolis Heart Institute at Abbott Northwestern Hospital, 920 East 28th Street, Suite 300, Minneapolis, MN 55407.
Dr. Creswell: Department of Cardiothoracic Surgery, University of Mississippi, 2500 North State Street, Jackson, MS 39216.
Ms. Thomas: Mayo School of Medicine, 200 1st Street Southwest, Rochester, MN 55905.
Ms. Tung: Johns Hopkins University School of Medicine, 733 North Broadway, Baltimore, MD 21205.
Ms. Isaacson: Medical College of Wisconsin, 8701 West Watertown Plank Road, Milwaukee, WI 53226.
Dr. Maron: Hypertrophic Cardiomyopathy Institute, Tufts Medical Center, 800 Washington Street, Boston, MA 02111.
Author Contributions: Conception and design: K.M. Harris, L.L. Creswell, E. Isaacson, B.J. Maron.
Analysis and interpretation of the data: K.M. Harris, L.L. Creswell, E. Isaacson, B.J. Maron.
Drafting of the article: K.M. Harris, L.L. Creswell, T. Thomas, B.J. Maron.
Critical revision for important intellectual content: K.M. Harris, L.L. Creswell, B.J. Maron.
Final approval of the article: K.M. Harris, L.L. Creswell, T.S. Haas, T. Thomas, M. Tung, E. Isaacson, R.F. Garberich, B.J. Maron.
Provision of study materials or patients: K.M. Harris, T.S. Haas.
Statistical expertise: R.F. Garberich.
Obtaining of funding: K.M. Harris.
Administrative, technical, or logistic support: L.L. Creswell, T.S. Haas, M. Tung.
Collection and assembly of data: K.M. Harris, L.L. Creswell, T.S. Haas, T. Thomas, M. Tung, E. Isaacson, B.J. Maron.
This article was published at Annals.org on 19 September 2017.

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Kevin M. Harris, Lawrence L. Creswell, Tammy S. Haas, et al. Death and Cardiac Arrest in U.S. Triathlon Participants, 1985 to 2016: A Case Series. Ann Intern Med.2017;167:529-535. [Epub 19 September 2017]. doi:10.7326/M17-0847

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