The First Large-scale Public Cardiac Screening to Protect Athletes Health in Hong Kong (CASPAR)

Transcription

1 The First Large-scale Public Cardiac Screening to Protect Athletes Health in Hong Kong Pre-participation Cardiovascular Screening Program for First-Time MArathon Runners (CASPAR)

2 Speakers Professor Hung-Fat Tse William M W Mong Professor in Cardiology Chair Professor Department of Medicine Li Ka Shing Faculty of Medicine The University of Hong Kong Dr Jo Jo Hai Clinical Assistant Professor Department of Medicine Li Ka Shing Faculty of Medicine The University of Hong Kong

3 Agenda Background International Screening Programs and Experiences CASPAR Patient Interview

4 Agenda Background International Screening Programs and Experiences CASPAR Patient Interview

5 Long-distance Running is Gaining More Popular in Hong Kong No of participants of the Hong Kong Standard Chartered Marathon Source: Hong Kong Amateur Athletic Association.

6 Benefits of regular physical activity Weight control Risk of diabetes Risk of some cancers Improve mental health Risk of heart diseases Strengthen bones and muscles Prevent falls Improve longevity Source: Centers for Disease Control and Prevention.

7 Regular physical activity reduces heart attack and sudden death Regular moderate exercise reduces cardiovascular risk by 20% Regular vigorous exercise reduces CV risk by 30-40% Over 8-year period, Regular vigorous exercise reduces mortality by 70% in men and 80% in women Source: Chugh SS, Weiss JB. JACC 2015.

8 Marathon running is not without risk. Sudden cardiac arrest among marathon runners 1 Incidence: 0.54 in 100,000 participants (Age: 42±13 years; male: 86%) Fatality: 71% Medical complications among marathon runners 2 65,865 participants: 2 deaths 37 medical complications (Myocardial ischemia: 8.1%; serious arrhythmias: 5.4%) Source: 1 Kim JH et al. NEJM 2012; 2 Schwabe K et al. Br J Sports Med 2014

9 Marathon running is not without risk. Year Participants Morbidity Hospital care required (Hospitalization required) Mortality ,000 1, , (27) ,000 1,100 9 (2) ,368 1, (3) ,272 5, (7) ,500 2, (7) ,438 6, (6) ,660 5, (9) 1

10 Cardiac events in a large-scale Marathon in Hong Kong A total of 4 subjects collapse with cardiac arrest over 10 years period 2 failed resuscitation Both subjects found to have significant narrowing of coronary arteries on postmortem examination 5 other subjects admitted for myocardial infarction Source: Chan K et al. Abstract. APHRS 2012.

11 Agenda Background International Screening Programs and Experiences CASPAR Patient Interview

12 Who are at risk of sudden cardiac death during exercise? Source: Chugh SS, Weiss JB. JACC Less experienced runners have more complications: vs per 1000 participants 2 Schwabe K et al. Br J Sports Med 2014

13 Who and why develops sudden cardiac death during exercise? Source: 1 Marijon E et al. Circulation 2011.

14 Pre-participation cardiovascular screening for athletes 35 years old is recommended by international professional bodies Family and personal history, physical examination (12-lead ECG) Negative Positive Eligible for participation Further Evaluation Negative Postivie Source: Corrado D et al. EHJ Maron BJ et al. JACC Diagnosis and Management

15 Pre-participation screening has shown evidence of improving health outcomes Italian pre-participation cardiovascular screening program Screens young athletes years who participated in an organized sports program Impact: Significant reduction of sudden cardiovascular death from 3.6 to 0.21 per 100,000 participantyears Source: Corrado D, et al. JAMA 2006.

16 Proposed Pre-participation screening of athletes >35 years old Pre-participation Self- Assessment Questionnaire Eligible for participation Negative Screening by physician (Hx, PE, RFs, ECG) Negative Maixmal exercise testing Positive Positive Positive Further evaluation Source: Chugh SS, et al. JACC Diagnosis and management

17 Pre-participation screening has shown evidence of improving health outcomes Switzerland pre-participation cardiovascular screening cohort Screening of athletes aged years old Family and personal history, Physical examination, ECG, risk-profile assessment by SCORE chart and blood tests Impacts: New Cardiovascular diagnoses detected in 2.8% Consider ineligible for high-intensity sports in 0.4% Source: Menafoglio A, et al. Br J Sports Med 2014.

18 Agenda Background International Screening Programs and Experiences CASPAR Patient Interview

19 Pre-participation Cardiovascular Screening Program for First-Time MArathon Runners CASPAR "Master of the Treasure" Supported by Sun Chieh Yeh Heart Foundation

20 CASPAR Aim of study To evaluate the effectiveness of CASPAR in identifying undiagnosed cardiovascular conditions To evaluate the effectiveness of CASPAR in identifying at-risk individuals To evaluate the effectiveness of CASPAR in reducing cardiovascular events as compared to historical control Supported by Sun Chieh Yeh Heart Foundation

21 Website Supported by Sun Chieh Yeh Heart Foundation

22 CASPAR Proposed Pre-participation screening of athletes >18 years old Negative Negative Stage 1: Pre-participation Self-Assessment Questionnaire Positive Stage 2:Physical examination,12-lead ECG Blood and urine tests Positive Negative Stage 3: Exercise stress test Eligible for participation Diagnosis and Management Supported by Sun Chieh Yeh Heart Foundation

23 Supported by Sun Chieh Yeh Heart Foundation

24 Supported by Sun Chieh Yeh Heart Foundation

25 Supported by Sun Chieh Yeh Heart Foundation

26 Supported by Sun Chieh Yeh Heart Foundation

27 Supported by Sun Chieh Yeh Heart Foundation

28 Supported by Sun Chieh Yeh Heart Foundation

29 CASPAR Our missions: Prevention of potentially avoidable sudden cardiac arrest during training and competition Early diagnosis of cardiovascular disease for appropriate intervention Increase public awareness of sports safety Supported by Sun Chieh Yeh Heart Foundation

30 CASPAR Please note: Some cardiovascular diseases cannot be identified with screening False positive and false negative Inability to reduce non-cardiovascular complications

31 Agenda Background International Screening Programs and Experiences CASPAR Patient Interview

32 Thank you for your time!