Sudden cardiac deaths in young people during exercise are fortunately rare but there is room to improve response to these tragic events.

A review of the National Coronial Information System database for cardiovascular deaths between 2000-2016 in young Australians aged 10-35 years identified 110 cases related to physical exercise.

The most common causes of death were coronary artery disease (CAD) (37%) and sudden arrhythmic death syndrome (20%).

The study found symptoms including chest pain, presyncope or syncope, general malaise and shortness of breath were apparent in 39% of cases before the event.

As well, most events occurred in settings such as sporting fields where there were witnesses and potential help on hand.

The study, published in the Internal Medicine Journal, said bystander CPR was initiated in 70% of the cases however use of AEDs prior to ambulance arrival was low 8%.

“The presence of symptoms prior to event, particularly chest pain and syncope, should raise immediate concern with early call to emergency medical services (EMS) and obtainment of a nearby AED if available,” the study said.

“Indeed every 30-minute delay between symptom onset and EMS reduces survival by 2.3% in out-of-hospital cardiac arrest (OHCA).”

The study found most cases were young males (92%) with a median age of death of 27 years.

CAD deaths occurred at a slightly higher age of 32 years compared to 24 years in other causes of deaths.

All 10 deaths in Aboriginal or Torres Strait Islanders were attributed to CAD.

“Cases of CAD had elevated BMI compared with those who died from causes other than CAD (31±7kg/m2 and 27±6kg/m2, respectively; p=0.03) and were more likely to have lived in regional or remote areas (32% versus 15%; p=0.05).”

The study said the number of deaths in people with an increased BMI was “of growing concern amidst rising obesity rates in western countries.”

The study, led by Dr Francis Ha from Austin Health and St Vincent’s Hospital Melbourne, said the median time to ambulance arrival was 12 minutes – which “highlights how crucial each second could be for achieving meaningful recovery.”

The investigators said ongoing barriers to effective CPR include lack of CPR knowledge or confidence, and time lost due to language or communication barriers between the bystander and the emergency call services.

“Targeted education regarding CPR competency and increased access and early utilisation of AED use are critical public health initiatives to ameliorate this tragic event.”

Other causes of death in the study included unspecified cardiomyopathy/cardiomegaly (15%), myocarditis (7%), arrhythmogenic right ventricular cardiomyopathy (6%), hypertrophic cardiomyopathy (4%) and dilated cardiomyopathy (3%).

Most sudden cardiac deaths occurred in the setting of AFL, running or jogging, soccer and rugby.