(P145) SUDDEN CARDIAC ARREST DURING PHYSICAL ACTIVITY: INCIDENCE AND CHARACTERISTICS

Background: While sudden cardiac arrest (SCA) during sport is well-recognized, events occurring during or immediately after non-sport physical activities are more common. Few studies have comprehensively described the incidence of physical activity-associated SCA.

METHODS AND RESULTS: C-SCAN is a multidisciplinary network measuring the scope of SCA across Canada. We conducted a retrospective cohort study, using Emergency Medical Services (EMS) records from two provinces (ON, NS) that covered an estimated population of 3.2 million. We included consecutive treated SCAs, ages 18-85 that had no obvious cause and occurred during or ≤ 1 hour after physical activity. We defined physical activities as any activity that was not performed for recreation or exercise. We defined low intensity activity as an estimated metabolic equivalent (MET) score ≤ 3, moderate as a MET score of 3-5.9, vigorous as ≥ 6, and moderate-vigorous if ≥ 3, but unsure if either moderate or vigorous.

5,512 SCAs occurred between January 1, 2016 - December 31, 2020, of which 743 (13.5%) were associated with physical activity (Figure 1). Most were male (77.9%; 579/743), with a median age of 66 years [IQR 57 – 75 years]. The overall incidence was 7.8 per 100,000 person-years (95% CI: 7.3-8.4), with males having an almost 4-fold higher incidence: 12.5 (95% CI: 11.5-13.5) compared to females 3.4 (95% CI: 2.9-3.9) per 100,000 person-years. SCA occurred during 51 unique physical activities, with walking being the most common among men and women (Figure 1). Intensity was light (61.9%; 460/743), moderate (24.9%; 185/743), moderate-vigorous (6.5%; 48/743), vigorous (0.7%; 5/743), or unknown (5.3%; 44/743). Most occurred in private locations (65.3%; 485/743), with most witnessed by bystanders (60.8%; 451/742) or EMS (10.2%; 76/742). Bystanders performed CPR in 58.1% (384/661) and administered AED shocks in 4.0% of cases (30/743). Median EMS response time was 6 minutes [IQR 5 – 8], with an initial shockable rhythm reported in 41.5% (298/718) of cases. EMS delivered shocks to 53.0% (394/743) of patients. Prehospital ROSC was achieved in 40.4% (300/742) of cases, and 77.3% (565/731) of patients were transported to hospital. Of the 97% with known final vital status, (19.2%; 138/720) survived to hospital discharge. Thirty percent (229/742) had documented symptoms ≤1 hours of the cardiac arrest, with dyspnea (11.4%; 85/742), chest pain (8.8%; 65/742), and feeling unwell (6.6%; 49/742) most common.

Conclusion: Physical activity-related SCAs frequently occur at home and are four times more common in men. Survivability, bystander CPR and shockable initial rhythms were relatively high.