Exercise-related out-of-hospital cardiac arrest in the general population: incidence and prognosis
Open accessAbstract
AIMS: Although regular physical activity has beneficial cardiovascular effects, exercise can trigger an acute cardiac event. We aimed to determine the incidence and prognosis of exercise-related out-of-hospital cardiac arrest (OHCA) in the general population. METHODS AND RESULTS: We prospectively collected all OHCAs in persons aged 10-90 years from January 2006 to January 2009 in the Dutch province North Holland. The relation between exercise during or within 1 h before OHCA and outcome was analysed using multivariable logistic regression, adjusted for age, gender, location, bystander witness, bystander cardiopulmonary resuscitation (CPR), automated external defibrillator (AED) use, initial rhythm, and Emergency Medical System response time. Of 2524 OHCAs, 143 (5.7%) were exercise related (7 ≤35 years, 93% men). Exercise-related OHCA incidence was 2.1 per 100 000 person-years overall and 0.3 per 100 000 person-years in those ≤35 years. Survival after exercise-related OHCA was distinctly better than after non-exercise related OHCA (46.2 vs. 17.2%) [unadjusted odds ratio (OR) 4.12; 95%CI 2.92-5.82; P < 0.001], even after adjustment for abovementioned variables (OR 2.63; 95%CI, 1.23-5.54; P = 0.01). In the 69 victims aged ≤35 years, exercise was not associated with better survival: 14.3 vs. 17.7% in non-exercise-related OHCA (OR 0.77; 95%CI 0.08-7.08; P = 0.82). CONCLUSION: Exercise-related OHCA has a low incidence, particularly in the young. Cardiac arrests occurring during or shortly after exercise carry a markedly better prognosis than non-exercise-related arrests in persons >35 years. This study establishes the favourable outcome of exercise-related OHCA and should have direct implications for public health programs to prevent exercise-related sudden death.
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Men have a higher probability of coronary atherosclerosis and risk of exercise-related cardiac arrest than women.
“We included only men because of their higher probability of coronary atherosclerosis and risk of exercise related cardiac arrest than women 21, 22”
From Relationship between lifelong exercise volume and coronary atherosclerosis in athletes. (2017) · cites this paper as [21]
The supplied passage reports that 93% of exercise-related out-of-hospital cardiac arrests were in men, supporting male predominance among the cases studied. It does not address whether men have a higher probability of coronary atherosclerosis, and the case proportion alone does not establish an individual risk comparison with women. (LLM, conf=0.83)
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Cites
Does sports activity enhance the risk of sudden death in adolescents and young adults?
Corrado, D., Basso, C., Rizzoli, G., Schiavon, M., & Thiene, G. (2003) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2003.03.002 · Cited by 1,311 · see citing works
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Franklin, B. A., Thompson, P. D., Al-Zaiti, S. S., Albert, C. M., Hivert, M.-F., Levine, B. D., Lobelo, F., Madan, K., Sharrief, A. Z., Eijsvogels, T. M. H., et al. (2020) · Circulation · doi:10.1161/cir.0000000000000749 · Cited by 410 · see citing works
Relationship between lifelong exercise volume and coronary atherosclerosis in athletes.
Aengevaeren, V. L., Mosterd, A., Braber, T. L., Prakken, N. H. J., Doevendans, P. A., Grobbee, D. E., Thompson, P. D., Eijsvogels, T. M. H., & Velthuis, B. K. (2017) · Circulation · doi:10.1161/circulationaha.117.027834 · Cited by 309 · see citing works
Self-citationAengevaeren, V. L., Mosterd, A., Bakker, E. A., Braber, T. L., Nathoe, H. M., Sharma, S., Thompson, P. D., Velthuis, B. K., & Eijsvogels, T. M. H. (2023) · Circulation · doi:10.1161/circulationaha.122.061173 · Cited by 115 · see citing works
Self-citationCoronary atherosclerosis in athletes: emerging concepts and preventive strategies
Claessen, G., Eijsvogels, T. M. H., Albert, C. M., Baggish, A. L., Levine, B. D., Marijon, E., Michos, E. D., & La Gerche, A. (2025) · European Heart Journal · doi:10.1093/eurheartj/ehae927 · Cited by 43 · see citing works
Ko, S. Y., Ro, Y. S., Shin, S. D., Song, K. J., Hong, K. J., & Kong, S. Y. (2018) · PLOS ONE · doi:10.1371/journal.pone.0193361 · Cited by 17 · see citing works
- Authors
- Berdowski, J., de Beus, M. F., Blom, M., Bardai, A., Bots, M. L., Doevendans, P. A., Grobbee, D. E., Tan, H. L., Tijssen, J. G. P., Koster, R. W., & Mosterd, A.
- Affiliations
- Amsterdam UMC Location University of Amsterdam (NL)
- University Medical Center Utrecht (NL)
- University Malaya Medical Centre (MY)
- Corresponding author
- Mosterd, A.
- ORCID
- Venue
- European Heart Journal
- Publisher
- Oxford University Press (OUP)
- Published
- 2013-10-03
- Volume
- 34
- Issue
- 47
- Pages
- 3616-3623
- ISSN
- 0195-668X (ISSN-L)
- 1522-9645
- OpenAlex
- W2075329634
- Cited by
- 148
- References
- 1
- Citations by year
- 2026: 1 · 2025: 12 · 2024: 7 · 2023: 11 · 2022: 7 · 2021: 6 · 2020: 16 · 2019: 9 · 2018: 14 · 2017: 21 · 2016: 14 · 2015: 21 · 2014: 8 · 2013: 1
- FWCI
- 14.49
- Type
- journal article
- Language
- en
- Open access
- green
- pure.amsterdamumc.nl
- Licence
- other-oa
- Locations
- European Heart Journal (publishedVersion)
- PubMed (publishedVersion)
- Pure Amsterdam UMC (publishedVersion, other-oa)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- HighWire Press Open Archive (submittedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
- Funders
- Universiteit van Amsterdam
- Topics
- Health Sciences › Medicine › Emergency Medicine › Cardiac Arrest and Resuscitation
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Effects of Exercise
- Health Sciences › Medicine › Physiology › Physical Activity and Health
- Keywords
- out-of-hospital cardiac arrest, incidence, prognosis, survival after cardiac arrest, sudden cardiac death, bystander CPR, automated external defibrillators, ambulance response time, young adults, physical activity
- MeSH terms
- Adolescent, Adult, Aged, Aged, 80 and over, Child, Female, Humans, Male, Middle Aged, Netherlands, Prognosis, Prospective Studies, Exercise, Incidence, Survival Rate, Age Distribution, Sex Distribution, Young Adult, Out-of-Hospital Cardiac Arrest
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