New Study: Sudden Death in Tri Hits This Age Group the Hardest

For years, researchers have struggled to understand why sudden cardiac death occurs during triathlon: is it because of panic attacks? Enlarged hearts? Undertrained athletes? Who is most at risk, and why? A new report, building on a landmark Triathlon Incidents Study from 2011 and published in this week’s Annals of Internal Medicine, may provide the clearest picture yet.

Using USA Triathlon (USAT) records, the U.S. National Registry of Sudden Death in Athletes, and personal reports from between 1985 and 2016, researchers identified 107 cases of race-related sudden death, 13 instances of resuscitated cardiac arrests and 15 trauma deaths. This is a larger study sample than any study before, allowing researchers to investigate correlations within the population.

“We’ve actually worked almost continuously since 2011 to gather information about victims [of sudden cardiac death in triathlon],” says Lawrence Creswell, MD, adult heart surgeon at the University of Mississippi Medical Center and researcher in the 2011 and 2017 reports. “In this latest report, there were a three important new—or more complete—avenues of investigation.”

First, the researchers made an exhaustive search to identify as many fatalities or survivors of cardiac arrest as possible. Expanding their search to include participants not only at USAT-sanctioned races, but other races as well, allowed the research team to get the most complete picture possible.

Another new development was access to autopsy records for the victims, either through public access or by gaining permission from victims’ family members. These provided important details that weren’t available in previous studies.

Finally, researchers used USAT’s athlete ranking system database to pull demographic data on the millions of athletes taking place in USAT sanctioned events in recent years, allowing researchers to tease out the influence of age and gender on athletes’ risk.

This analysis of the larger group of victims confirms some of the findings from the 2011 study:
– The majority of victims are male
– Almost 40% of victims were first-time triathlon participants
– No elite or professional athletes were among the victims
– The risk is similar regardless of the race distance
– The majority of deaths occur during the swim segment

But there’s new information in the updated study, too. The more complete findings include:
– Among the expanded group of victims, heart disease was found in nearly 50% of victims
– The risk for women is much lower than for men
– In women, the risk increases slightly with aging; In men, the risk increases dramatically with aging.

There are two important takeaway messages, says Creswell:

“First, our findings suggest that male triathletes who have reached middle age should, along with their physicians, pay particular attention to their heart health. This is the clearly the group of athletes with the greatest risk. Second, the pattern of fatalities suggests that race organizers should focus their efforts specifically on safety planning and execution for the swim segment.”

This increased awareness and planning can and does have an impact. Creswell is encouraged by a decrease of deaths in the sport since the 2011 USAT report: “There have been fewer fatalities in the most recent years—and only a single death this year at USAT-sanctioned races. I believe that our efforts at bringing awareness of the importance of heart health among participants and the importance of safety planning for the swim segment have already paid dividends.”