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)
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
Agenda Background International Screening Programs and Experiences CASPAR Patient Interview
Agenda Background International Screening Programs and Experiences CASPAR Patient Interview
2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 Long-distance Running is Gaining More Popular in Hong Kong No of participants of the Hong Kong Standard Chartered Marathon 80000 60000 40000 20000 0 Source: Hong Kong Amateur Athletic Association.
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.
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.
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
Marathon running is not without risk. Year Participants Morbidity Hospital care required (Hospitalization required) Mortality 2015 62,000 1,152 40 1 2012 59,175 951 38 (27) 1 2011 55,000 1,100 9 (2) 0 2010 52,368 1,425 55 (3) 0 2009 51,272 5,575 27 (7) 0 2008 42,500 2,350 31 (7) 0 2007 37,438 6,249 35 (6) 0 2006 35,660 5,092 22 (9) 1
Cardiac events in a large-scale Marathon in Hong Kong 2002-2012 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.
Agenda Background International Screening Programs and Experiences CASPAR Patient Interview
Who are at risk of sudden cardiac death during exercise? Source: Chugh SS, Weiss JB. JACC 2015. Less experienced runners have more complications: 16.44 vs 10.62 per 1000 participants 2 Schwabe K et al. Br J Sports Med 2014
Who and why develops sudden cardiac death during exercise? Source: 1 Marijon E et al. Circulation 2011.
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 2005. Maron BJ et al. JACC 2014. Diagnosis and Management
Pre-participation screening has shown evidence of improving health outcomes Italian pre-participation cardiovascular screening program Screens young athletes 12-35 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.
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 2015. Diagnosis and management
Pre-participation screening has shown evidence of improving health outcomes Switzerland pre-participation cardiovascular screening cohort Screening of athletes aged 35-65 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.
Agenda Background International Screening Programs and Experiences CASPAR Patient Interview
Pre-participation Cardiovascular Screening Program for First-Time MArathon Runners CASPAR "Master of the Treasure" Supported by Sun Chieh Yeh Heart Foundation
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
Website http://sc-marathon.ga/ Supported by Sun Chieh Yeh Heart Foundation
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
Supported by Sun Chieh Yeh Heart Foundation
Supported by Sun Chieh Yeh Heart Foundation
Supported by Sun Chieh Yeh Heart Foundation
Supported by Sun Chieh Yeh Heart Foundation
Supported by Sun Chieh Yeh Heart Foundation
Supported by Sun Chieh Yeh Heart Foundation
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
CASPAR Please note: Some cardiovascular diseases cannot be identified with screening False positive and false negative Inability to reduce non-cardiovascular complications
Agenda Background International Screening Programs and Experiences CASPAR Patient Interview
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