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2017-09-19 8:42 PM


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Subject: Risk of death and triathlon
I noticed this posted on another board I participate in and am wondering if some people here would comment. I wonder why the rate of death is so high during the swim portion?

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BMJ article

Men over 40 are most at risk of sudden death during triathlons
BMJ 2017; 358
doi: https://doi.org/10.1136/bmj.j4326
Published 19 September 2017
http://www.bmj.com/content/358/bmj.j4326


Original Paper

Death and Cardiac Arrest in U.S. Triathlon Participants, 1985 to 2016: A Case Series.
Ann Intern Med.
[Epub ahead of print 19 September 2017]
doi: 10.7326/M17-0847
http://annals.org/aim/article/2654457/d... -2016-case

Abstract
Background:

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

Objective:
To describe death and cardiac arrest among triathlon participants.

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 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.


2017-09-19 9:02 PM
in reply to: drew_ab


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25
Subject: RE: Risk of death and triathlon
By the way, I did come across a response to the same issue (albeit a different article) attempting to shed light into the death rate during the swim:

Letters
July 21, 2010
Causes of Sudden Death During the Triathlon—Reply
Kevin M. Harris, MD; Jason T. Henry, BA; Barry J. Maron, MD
Article Information
JAMA. 2010;304(3):269-270. doi:10.1001/jama.2010.983
In Reply: We agree with Dr Constantini and colleagues that understanding the precise mechanisms and circumstances underlying these sudden deaths would be ideal and aid substantially in the prevention of such catastrophes in the future. They are correct to suggest that a simple loss of consciousness, which would be readily identifiable on the ground, may not be as easily noted in the water. Although rescue personnel are situated on rafts or watercraft during triathlons, identification and rescue is particularly challenging in the open water environment.1 Although marathon runners with cardiac arrest have a reasonable chance at successful resuscitation with defibrillation,2 this is not as likely when athletes experience life-threatening events in open water. Furthermore, it is likely that triathlon competition includes novice swimmers who train primarily in pools; they may be unaccustomed to open water competitive swimming, during which it is not possible to rest or stop, and drowning may result. We agree with the suggestion for improved and systematic monitoring of the swim competition.

Constantini et al have also raised a number of questions surrounding the circumstances of collapse and death. Because of our retrospective study design, we can provide little reliable data for the cases beyond that included in the Research Letter. Although pulmonary edema was found in each of the triathletes dying during swimming, it is unresolved whether this was the primary cause of death (drowning) or a finding secondary to a cardiovascular disease–related arrhythmia. Water temperature was available in only a minority of these events.

Constantini et al indicate several plausible mechanisms for sudden death during triathlon, including long QT syndrome. There are a number of possible cardiovascular causes during the triathlon swimming segment, and that is why we suggested that individual athletes undergo preparticipation examinations to prevent future events. However, it is impractical to promote mandatory screening with electrocardiograms for all athletes participating in large public athletic events such as the triathlon.3

Back to top Article Information
Financial Disclosures: None reported.

References
1.
Dallam GM, Jonas S, Miller TK. Medical considerations in triathlon competition: recommendations for triathlon organisers, competitors and coaches. Sports Med. 2005;35(2):143-161PubMedArticle
2.
Roberts WO, Maron BJ. Evidence for decreasing occurrence of sudden cardiac death associated with the marathon. J Am Coll Cardiol. 2005;46(7):1373-1374PubMedArticle
3.
Maron BJ, Araújo CG, Thompson PD, et al; World Heart Federation; International Federation of Sports Medicine; American Heart Association Committee on Exercise, Cardiac Rehabilitation, and Prevention. Recommendations for preparticipation screening and the assessment of cardiovascular disease in masters athletes: an advisory for healthcare professionals from the working groups of the World Heart Federation, the International Federation of Sports Medicine, and the American Heart Association Committee on Exercise, Cardiac Rehabilitation, and Prevention. Circulation. 2001;103(2):327-334PubMedArticle
2017-09-19 9:45 PM
in reply to: drew_ab

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Subject: RE: Risk of death and triathlon
I've heard of two deaths since I started triathlons, and both were in the swim portion.

I've heard a lot about panic in the swim portion and my guess is that there is some relation here. There was a death in the swim portion a few months ago in a race I participated in. I was doing the sprint distance and the swimmers for the Olympic distance already had started. Big waves. Older gentleman. My guess is again panic. They were attempting resuscitation while all of us waiting to start the sprint race watched from a distance with our jaws dropped.

Lessons: If you're not strong in the swim, go for a shorter distance. If you're not strong in the swim, make it a point to do some open water practice- lots if necessary. Organizers, use the rolling start. Mass starts are ridiculous and accomplish nothing.
2017-09-20 4:04 AM
in reply to: Trilogy

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Subject: RE: Risk of death and triathlon
I guess you have a better chance of surviving an heart attack (or fainting) if you are not going to drown directly
2017-09-20 4:47 PM
in reply to: drew_ab

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Subject: RE: Risk of death and triathlon
If you're going to die, the swim is the best place to do it. So embarrassing to die on the bike or run.
2017-09-22 3:23 PM
in reply to: drew_ab

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Subject: RE: Risk of death and triathlon

There have been several deaths in recent years at marathons and half marathons, so it's not just a triathlon thing.



2017-09-22 3:57 PM
in reply to: drew_ab

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Ventura, California
Subject: RE: Risk of death and triathlon

Old farts with unknown bad hearts trying to get healthy go running into 55* water and suffer a instant cardiac stress response which manifests into cardiac arrest, which leads to drowning. Pretty simple really.

I am 47, only 3 years ago I was a previous overweight drinker and smoker. unknown condition of heart, perfect candidate for death on the swim. Will let you know if I survive this weekends 70.3 with a swim in the rather unforgiving Pacific Ocean. With 2 loops no less. So I get to swim against the heavy surf then get thrashed again by the heavy surf coming in, stand up quickly and run 100 yards across the beach in the sand, then thrash back against the waves and do it all again. 

See you on the other side

 

2017-09-22 7:02 PM
in reply to: rjcalhoun

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Subject: RE: Risk of death and triathlon
I'm always pretty surprised at the number of people that are clearly not in that great of shape that sign up for Oly distance races. 1.5K meters is far from an easy swim if you don't have good mechanics. And most of triathletes come to swimming later in life. Yep, I have little doubt that some folks get in trouble during the swim.
2017-09-23 1:24 PM
in reply to: Trilogy

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Subject: RE: Risk of death and triathlon

Originally posted by Trilogy I've heard of two deaths since I started triathlons, and both were in the swim portion. I've heard a lot about panic in the swim portion and my guess is that there is some relation here. There was a death in the swim portion a few months ago in a race I participated in. I was doing the sprint distance and the swimmers for the Olympic distance already had started. Big waves. Older gentleman. My guess is again panic. They were attempting resuscitation while all of us waiting to start the sprint race watched from a distance with our jaws dropped. Lessons: If you're not strong in the swim, go for a shorter distance. If you're not strong in the swim, make it a point to do some open water practice- lots if necessary. Organizers, use the rolling start. Mass starts are ridiculous and accomplish nothing.

I've been at 3 races where there were deaths.  The first was the Philadelphia Triathlon when a guy suffered a cardiac event like those in this study.  The second two were in the same weekend at Musselman, with both occurring on the bike - The first was the Saturday sprint when a guy apparently was riding with his head down, and plowed into the back of a parked mini van at full speed on a flat straight.  The second was the Sunday HIM when a woman hit a bike bottle at an an aid station and hit her head when she fell.  One of my athletes was right behind her and saw it happen, and she passed a few days latter in the hospital.

The two Musselman deaths both could have been prevented by the athletes riding more cautiously.  The Philadelphia one, may or many not have not been preventable, and is consistent with the ones contemplated by this study.

There are inherent risks in any physical activity.  Assuming best practices are followed - training to be a proficient and confident swimmer, plenty of time in open water, a good warm up, and regular cardiac checkups, the chances of a cardiac death appear to be reduced, but most of these situations appear to be undiagnosed medical conditions that were going to occur at some point without prior medical intervention.  If it wasn't during a triathlon, it would have been while shoveling snow or moving furniture.

Personally, I believe the difference in death rates during triathlon swims is eventually going to be determined to be attributable in great part to the nature of the event - It's more difficult to recognize that someone is having a medical issue during the swim, it takes longer for help to arrive, and longer to get the person to an AED for help.  Those are some crucial minutes lost.

 

2017-09-25 7:05 AM
in reply to: TriMyBest

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Subject: RE: Risk of death and triathlon
Maybe this thread should die. It's morbid! :-)
2017-09-26 2:35 AM
in reply to: 0

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Kingston Upon Thames, England
Subject: RE: Risk of death and triathlon
Most of these deaths are underlying problems under discovered. I would advise anybody doing triathlons to get checked out, like a ECG test with your Doctor, especially over 40's. I had an unfortunate out of hospital cardiac arrest almost 3 years ago, riding my bike home from work in the summer, I felt dizzy parked down near the river next minute I awoke in hospital coming out of a 24 hour induced coma. Two off duty Doctors saved me with CPR, I was out for 18 minutes, luckily there was no damage during my ordeal other than broken ribs. My LAD artery was blocked (aka as the Widow Maker), all other arteries were clean, I have a drug eluting stent. At the time my resting HR was 42-43, I'm 6 foot weighed 72kgs.
1 year after I competed in a mountain cycling sportive in France and finished top 10 in my age group. I was fit at the time, looks like the problem was heredity. Played sport all my life, so you never know, get checked out.

You put a huge amount of stress in your heart especially during the longer events like Ironman. During a hot day the HR will increase 10-20 beats sometimes. I always build base now, rather than a few intensity sessions per week now I'm in my late 40's, just not worth it. If I can keep my HR to about 130-140 average on a 100 mile bike ride or a 130-155 on a 15 mile run and similar on a 2k swim that's fine with me. I still put farlek training with intensity but a lot less these days, once a week if that. I'm seeing a highly respective Sports Cardiologist in London who helping me out.

And the swim, usually swimming can be high intensity and especially if the technique is not good your using so much more energy and heart stresses. Something I'm trying to work on! So death during the swim doesn't surprise me. I met a guy who competed in Kona 9 times usually top 20 in his age group who had a heart attack, can happen to anyone. Be safe!



Edited by mortirolo 2017-09-26 2:51 AM


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