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"No young athlete should die from an undiagnosed heart condition"
Champs Fund (The Hicham El Hage Program for Young Hearts & Athletes Health) is a charitable fund established in April 2014 within the department of Family Medicine at the American University of Beirut Medical Center. The Fund is founded in memory of Hicham El Hage, a 15 year old young athlete who collapsed on the football field while practicing with his school team on May 1, 2010 due to an undiagnosed hypertrophic cardiomyopathy.
The Fund aims at preventing sudden cardiac death in young athletes through advocating for mandatory cardiac screening of athletes, raising public awareness regarding cardiac risk in the young, and ensuring better preparedness and safety of the sports areas through the availability of Automated External Defibrillators (AEDs) & Cardiopulmonary resuscitation (CPR)-certified coaches.
Sudden cardiac arrest is the leading cause of death among young athletes (aged 12 to 35 years) worldwide. In the United Kingdom, 12 young people are reported to die suddenly every week and in the United States of America, one young person is reported to die every 2 to 3 days. Several international scientific societies and international sports organizations recommend conducting cardiac screening before enrollment in competitive sports. Moreover, prompt CPR and utilization of AED have been shown to improve the chance of survival of a young athlete in sudden cardiac arrest.
Since its establishment, Champs Fund has been active at different levels in order to fulfill its mission. Activities were conducted at the level of advocacy, raising awareness, providing free cardiac screening and capacity building of relevant professionals. These activities are highlighted below:
An advocacy meeting with sports leagues and clubs in Lebanon in the presence of the Minister of Youth and Sports was held on August 29, 2014 where the need to make pre-participation exam mandatory for all athletes and ensure safe sports fields (trained coaches on performing CPR and having AEDs in the sports fields) was discussed.
Training of 30 doctors from different primary health centers in Lebanon on performing pre-participation exams and reading electrocardiogram (EKG) for athletes.
Launching a "Back to School Free Heart Screening" for young school and university students (aged 12-24 years) who play competitive sports. The screening was done over the period extending from September through end of November 2014 and covered more than 300 young athletes from different universities and schools in Lebanon.
Conducting cardiac screening for athletes within the premises of their schools, universities and sports’ clubs. This has improved accessibility to young athletes for cardiac screening. The first screening was conducted in Collège Protestant Français in Beirut; plans are on going to cover other schools, universities and sports clubs in different regions in Lebanon.
Training of sports trainers/coaches on CPR and use of AEDs in collaboration with the Life Support Center-Nursing Department-American University of Beirut Medical Center. Participants receive a Heartsaver certification for 2 years from the American Heart Association. Around 100 coaches received this training so far.
Sudden Cardiac Death in Young Athletes
Sudden cardiac death can unfortunately be the FIRST and ONLY presentation of an underlying heart condition in young athletes aged 12 to 35 years old. The incidence of sudden cardiac death in young athletes has been estimated to be around 1-3 in 100,000 in different countries; and it is reported to be around 2.5 to 2.8 fold higher in young athletes as compared to age-matched non-athletes (2, 3).
Sudden cardiac death due to cardiac disease did in fact affect several internationally renowned athletes over the years : Marathon runner Jim Fixx (1984), Olympic volleyball player, Flo Hyman (1986), former basketball star, Pete Maravich (1988), college basketball star, Hank Gathers (1990), professional basketball All-Star, Reggie Lewis (1993), Olympic figure skating champion, Sergei Grinkov (1995), football player, Marc Vivian Foe (2003), and football player, Miklos Feher (2004). Sports are not the direct cause of sudden death; yet, exercise triggers sudden death in athletes affected by cardiovascular conditions. The main cardiovascular conditions causing sudden death in young competitive athletes aged less than 35 years include the following: Hypertrophic cardiomyopathy, arrythmogenic right ventricular cardiomyopathy, congenital anomalies of coronary arteries, myocarditis, aortic rupture, valvular heart disease, pre-excitation syndromes and conduction diseases, ion channel disease and congenital heart disease . Hypertrophic cardiomyopathy remains the leading cause of sudden death among athletes, and it is the most common form of heritable or genetic heart disease with a prevalence estimated at 0.2 % (i.e. 1 in 500 people) in the general population.
Screening programs for pre-participation in competitive sports are endorsed by international societies:
The American Heart Association recommends using a health questionnaire and a physical examination when screening young athletes.
The European Society of Cardiology and major international sporting bodies (International Olympic Committee and Federation International de Football) mandate cardiac screening of athletes including an electrocardiogram (EKG).
In Italy, screening of participants in representative sports is mandatory. The screening program using an EKG, in addition to medical history and physical examination, has shown a significant reduction (89%) in the incidence of sudden cardiac death over a 25-year period.
The inclusion of an EKG in the pre-participation screening for prevention of sudden cardiac death in young athletes was found to improve the overall sensitivity of pre-participation cardiovascular screening in athletes and to be cost-effective.
It is important to note that it is possible to diagnose most of the cardiac abnormalities in young athletes and provide treatment options. Treatment can include medical treatment, procedures, or the insertion of an implantable cardioverter defibrillator.
Another important measure that needs to be taken into consideration to prevent sudden cardiac death is the use of AED and prompt CPR when faced with a person in sudden cardiac arrest. In fact, better survival rates have been reported in literature with the prompt use of defibrillation.
Corrado D, Basso C, Schiavon M, Pelliccia A, Thiene G. Pre-participation screening of young competitive athletes for prevention of sudden cardiac death. J Am Coll Cardiol. 2008 Dec 9; 52(24): 1981-9. 2. Wheeler MT, Heidenreich PA, Froelicher VF, Hlatky MA, Ashley EA.
Cost-Effectiveness of Preparticipation Screening for Prevention of Sudden Cardiac Death in Young Athletes. Ann. Intern. Med. 2010; 152: 276-286.
Corrado D, Basso C, Rizzoli G, Schiavon M, Thiene G. Does sports activity enhance the risk of Sudden death in adolescents and young adults. J Am Coll Cardiol 2003; 42:1959–63.
Koester M. A Review of Sudden Cardiac Death in Young Athletes and Strategies for Preparticipation Cardiovascular Screening. Journal of Athletic training 2001; 36(2): 197-204.
Corrado D, Basso C, Schiavon M, Pelliccia A, Thiene G. Does sports activity enhance the risk of sudden cardiac death? J Cardiovasc Med 2006; 7: 228-233.
Morita H, Larson MG, Barr SC, Vasan RS, O'Donnell CJ, Hirschhorn JN, Levy D, Corey D, Seidman CE, Seidman JG, Benjamin EJ: Single-gene mutations and increased left ventricular wall thickness in the community: the Framingham Heart Study. Circulation 2006, 113:2697-2705.
Maron BJ, Seidman CE, Ackerman MJ, Towbin JA, Maron MS, Ommen SR, Nishimura RA, Gersh BJ: How should hypertrophic cardiomyopathy be classified?: What's in a name Dilemmas in nomenclature characterizing hypertrophic cardiomyopathy and left ventricular hypertrophy. Circ Cardiovasc Genet 2009, 2:81-85; discussion 86.
Maron BJ, Thompson PD, Ackerman MJ, Balady G, Berger S, Cohen D et al (2007) Recommendations and considerations related to preparticipation screening for cardiovascular abnormalities in competitive athletes: 2007 update: a scientific statement from the American Heart Association Council on Nutrition, Physical Activity, and Metabolism: endorsed by the American College of Cardiology Foundation. Circulation 2007; 115:1643–1655
Corrado D, Basso C, Pavei A, Michieli P, Schiavon M, Thiene G. Trends in sudden cardiovascular death in young competitive athletes after implementation of a preparticipation screening program. JAMA 2006; 296:1593–601.
Sharma S. Point/Mandatory ECG screening of young competitive athletes. Heart Rhythm Society 2012; 9: 1642-1645.
Baggish AL, Hutter AM Jr, Wang F, Yared K, Weiner RB, Kupperman E, Picard MH, Wood MJ. Cardiovascular screening in college athletes with and without electrocardiography: A cross-sectional study. Ann Intern Med. 2010 Mar 2; 152 (5):269-75.
Corrado D, Drezne Jr, Basso B, Pelliccia A, Gaetano TT. Strategies for the prevention of sudden cardiac death during sports. European Journal of Cardiovascular Prevention & Rehabilitation 2011; 18: 197-208.
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