Original research| Volume 25, ISSUE 9, P705-709, September 2022

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Epidemiology of sudden cardiac death and sudden cardiac arrest with resultant disability during high school organized sport in Japan



      To examine the incidence and survival rates of sudden cardiac arrest that were documented during school organized sports in Japan.


      Retrospective cohort study.


      Insurance claim data of cardiac events (sudden cardiac death and sudden cardiac arrest with resultant disabilities) that occurred during Japanese high school organized sports between 2009 and 2018 were retrieved. Participation data from All Japan High School Athletic Federation and Japan High School Baseball Federation were used for incidence rate calculations. Incidence rate ratios with 95 % confidence interval were calculated to compare the risk by sports and sex. The survival rate was calculated with the proportion of resuscitated cases to total number of cardiac events in this dataset.


      A total of 55 cardiac events (25 survivors and 30 deceased) were identified in the dataset. The majority affected male student-athletes (92.7 %). The frequency and incidence rate of cardiac events were highest in male baseball (n = 16 [29.1 %], incidence rate: 0.91 per 100,000 athlete-years). Incidence rate ratio revealed that male basketball (2.19, 95 % confidence interval: 1.04–4.60), male baseball (2.31, 95 % confidence interval: 1.32–4.03), and first-year male baseball (4.11, 95 % confidence interval: 2.10–8.07) had significantly higher risk of cardiac events, compared to the overall incidence rate (0.38 per 100,000 athlete-years). The survival rates were 37.5 % in the first half (2009–2013) and 56.5 % in the latter half (2014–2018) of the study period.


      The risk of cardiac events was highest in male, baseball, first-year student-athletes. Rapid AED application by bystanders should be advocated to enhance better survival.


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        • Malhotra A.
        • Dhutia H.
        • Finocchiaro G.
        • et al.
        Outcomes of cardiac screening in adolescent soccer players.
        N Engl J Med. 2018; 379: 524-534
        • Maron B.J.
        • Haas T.S.
        • Murphy C.J.
        • et al.
        Incidence and causes of sudden death in U.S. college athletes.
        J Am Coll Cardiol. 2014; 63: 1636-1643
        • Endres B.D.
        • Kerr Z.Y.
        • Stearns R.L.
        • et al.
        Epidemiology of sudden death in organized youth sports in the United States, 2007-2015.
        J Athl Train. 2019; 54: 349-355
        • Hosokawa Y.
        • Murata Y.
        • Stearns R.L.
        • et al.
        Epidemiology of sudden death in organized school sports in Japan.
        Inj Epidemiol. 2021; 8: 27
        • Suzuki-Yamanaka M.
        • Hosokawa Y.
        • Ayusawa M.
        • et al.
        Epidemiology of sports-related fatalities during organized school sports in Japanese high schools between 2009 and 2018.
        PLoS One. 2021; 16e0256383
        • Drezner J.A.
        • Rao A.L.
        • Heistand J.
        • et al.
        Effectiveness of emergency response planning for sudden cardiac arrest in United States high schools with automated external defibrillators.
        Circulation. 2009; 120: 518-525
        • Toresdahl B.G.
        • Rao A.L.
        • Harmon K.G.
        • et al.
        Incidence of sudden cardiac arrest in high school student athletes on school campus.
        Heart Rhythm. 2014; 11: 1190-1194
        • Landry C.H.
        • Allan K.S.
        • Connelly K.A.
        • et al.
        Sudden cardiac arrest during participation in competitive sports.
        N Engl J Med. 2017; 377: 1943-1953
        • Sado J.
        • Kiyohara K.
        • Kitamura T.
        • et al.
        Sports activity and paediatric out-of-hospital cardiac arrest at schools in Japan.
        Resuscitation. 2019; 139: 33-40
        • Peterson D.F.
        • Kucera K.
        • Thomas L.C.
        • et al.
        Aetiology and incidence of sudden cardiac arrest and death in young competitive athletes in the USA: a 4-year prospective study.
        Br J Sports Med. 2021; 55: 1196-1203
        • Finocchiaro G.
        • Papadakis M.
        • Robertus J.L.
        • et al.
        Etiology of sudden death in sports: insights from a United Kingdom regional registry.
        J Am Coll Cardiol. 2016; 67: 2108-2115
        • Haneuse S.
        Introduction to categorical statistics.
        in: Lash T.L. VanderWeele T.J. Haneuse S. Rothman K.J. Modern epidemiology. fourth edition. Wolters Kluwer, Philadelphia, PA2021: 395-414
        • Harmon K.G.
        • Asif I.M.
        • Maleszewski J.J.
        • et al.
        Incidence, cause, and comparative frequency of sudden cardiac death in National Collegiate Athletic Association Athletes: a decade in review.
        Circulation. 2015; 132: 10-19
        • Japan Circulation Society and Japanese Society of Pediatric Cardiology and Cardiac surgery
        Guidelines for heart disease screening in schools.
        • National Athletic Trainers'’ Association
        Recommendations and guidelines for appropriate medical coverage of intercollegiate athletics.
        (Published 2007. Accessed February 13, 2021)
        • Okabe Y.
        • Tomozoe H.
        • Kasuga Y.
        The transformation of konjo in the 1960s, focusing on the role to The Tokyo Olympic Games.
        Japan J Phys Educ Hlth Sport Sci. 2012; 57: 129-142
        • Boden B.P.
        • Ahmed A.E.
        • Fine K.M.
        • et al.
        Baseline aerobic fitness in high school and college football players: critical for prescribing safe exercise regimens.
        Sports Health. 2022; 14: 490-499
        • Kiyohara K.
        • Sado J.
        • Kitamura T.
        • et al.
        Public-access automated external defibrillation and bystander-initiated cardiopulmonary resuscitation in schools: a nationwide investigation in Japan.
        Europace. 2019; 21: 451-458
        • Kitamura T.
        • Kiyohara K.
        • Sakai T.
        • et al.
        Public-access defibrillation and out-of-hospital cardiac arrest in Japan.
        N Engl J Med. 2016; 375: 1649-1659
        • Mitamura H.
        • Iwami T.
        • Mitani Y.
        • et al.
        Aiming for zero deaths: prevention of sudden cardiac death in schools–statement from the AED Committee of the Japanese Circulation Society.
        Circ J. 2015; 79: 1398-1401
        • Rose K.
        • Martin Goble M.
        • Berger S.
        • et al.
        Cardiac emergency response planning for schools: a policy statement.
        NASN Sch Nurse. 2016; 31: 263-270
        • Andersen J.
        • Courson R.W.
        • Kleiner D.M.
        • et al.
        National Athletic Trainers’ association position statement: emergency planning in athletics.
        J Athl Train. 2002; 37: 99-104