A high incidence of serious life-threatening cardiovascular medical encountersduring a marathon (2014–2019) calls for prevention strategies: SAFER XL

Abstract

Objective: The aim of this study was to determine the incidence and nature (severity and type by organsystem and specific diagnosis) of all medical encounters (MEs), including serious/life-threatening MEs(SLMEs) during a South African road marathon.Methods: This descriptive study was a retrospective analysis of data collected over 6 years at the CapeTown Marathon from 2014 to 2019, which included 40 446 starters. All MEs were collected anddescribed as per the consensus statement for mass community-based sporting events. Incidences (I;per 1000 starters; 95% CI) are described for all MEs, SLMEs, and by organ system and specific diagnosis.Results: The incidence of all MEs was 8.7 (95% CI: 7.8–9.6) per 1000 starters. The largest contributor toall MEs, by organ system affected, was cardiovascular-related, with an incidence of 1.8 (95% CI: 1.4–2.2),where exercise-associated postural hypotension was the most common specific diagnosis (I = 1.3; 95%CI: 1.0–1.7). The incidence of all SLMEs was 1.0 (95% CI: 0.7–1.4) making up 11.7% (41/350) of all MEs.The incidence of SLMEs by organ system was highest in the cardiovascular system (I = 0.4; 95% CI: 0.3–0.7), with acute coronary syndrome (ACS) (I = 0.2; 95% CI: 0.1–0.4) the most common specific diagnosis.There were no sudden cardiac deaths (SCD) nor sudden cardiac arrests (SCA).Conclusion: There was a high proportion of cardiovascular-related medical encounters, as well asSLMEs. We recommend that event organizers and race medical directors investigate preventionstrategies to mitigate against risk of SLMEs, specifically acute cardiovascular SLMEs.