Interesting article. They recommend better screening of participants.
In Triathlons, Swimming Poses Greatest Risk of Death
By John Gever, Senior Editor, MedPage Today
Published: April 06, 2010
Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco and
Dorothy Caputo, MA, RN, BC-ADM, CDE, Nurse Planner Earn CME/CE credit
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Most triathlon participants who drop dead during the competition do so in the water, researchers said.
Investigation of 14 sudden deaths among triathletes from 2006 to 2008 showed that all but one occurred during the swimming portion, reported Kevin M. Harris, MD, of the Minneapolis Heart Institute of Abbott Northwestern Hospital in Minneapolis, and colleagues.
No deaths occurred during running events. One participant died after a bicycle crash.
All the swimming deaths were officially attributed to drowning, "but seven of nine athletes with autopsy had cardiovascular abnormalities identified," the investigators wrote in a research letter appearing in the April 7 Journal of the American Medical Association.Action Points
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Explain to interested patients that triathlons typically involve strenuous exertion that may contribute to sudden cardiac death in patients not in top physical shape.
Explain that a cardiovascular stress test and other evaluations may be warranted for individuals seeking to train for or participate in triathlons for the first time.
Harris and colleagues recommended that triathlon organizers set minimum achievement standards for participants, "including swimming proficiency."
The apparent cardiovascular risk should motivate individual competitors to be evaluated before racing, but mass screening of participants is probably impractical, the researchers also noted.
The JAMA letter updates data reported by Harris at the 2009 American College of Cardiology annual meeting.
He and colleagues reviewed data on some 959,000 participants in events sanctioned by USA Triathlon, the major standard-setting organization for such events, from January 2006 through September 2008. The data were collected by this group and the U.S. Registry of Sudden Deaths in Athletes.
The 14 deaths translated to a rate of 1.5 per 100,000 participants, the researchers reported.
A total of 2,971 events were included in the analysis. Distances were relatively short in 45% of events, medium in 40%, and long in 15%.
For the swimming portions, these categories were defined as less than 750 meters for short events, from 750 to 1,500 meters for medium distances, and more than 1,500 meters for long triathlons.
Six of the swimming deaths happened in short events, four in medium-distance swims, and three in long races. Two of the latter were so-called Ironman triathlons in which the swims are 3,860 meters (2.4 miles).
Death rates per 100,000 participations in these swim distance categories were:
Short: 1.4 (95% CI 1.1 to 3.1)
Medium: 1.0 (95% CI 0.4 to 2.8)
Long: 2.8 (95% CI 1.0 to 7.5)
In eight of the fatal swimming incidents, the participants were noted to have called for help; five were found motionless in the water after other swimmers had moved on.
Although 41% of participants were female, only two of the 13 swimming deaths involved women.
Besides gender, another contributing factor was the number of competitors in a given race, according to Harris and colleagues.
The mean number of participants in triathlons in which an athlete died was 1,319 (95% CI 1,084 to 1,584), compared with 318 in races without deaths (95% CI 302 to 334), they reported.
"Because triathlons begin with chaotic, highly dense mass starts, involving up to 2,000 largely novice competitors entering the water simultaneously, there is opportunity for bodily contact and exposure to cold turbulent water," Harris and colleagues wrote.
They also noted that triathlon swimmers in distress may not attract attention as quickly as a troubled bicyclist or runner.
One large study found a death rate of 0.8 per 100,000 among marathon runners, half that in the current triathlon study.
In the seven dead swimmers with autopsy findings showing cardiovascular abnormalities, six had mild left ventricular hypertrophy. Their maximum cardiac wall thickness was 15 to 17 mm and the mean heart weight was 403 grams (SD 77). One of these individuals had a clinical history of Wolff-Parkinson-White syndrome.
The seventh athlete was found to have a congenital coronary arterial anomaly.
Harris and colleagues noted that their data may not have included every athlete who died during a triathlon, as such deaths are not subject to mandatory reporting. The study was also limited to events sanctioned by USA Triathlon, leaving out an unknown number of other competitions. Finally, some athletes likely participated in multiple events included in the study.
The Hearst Foundation supported the study.
No potential conflicts of interest were reported.
Primary source: Journal of the American Medical Association
Source reference:
Harris K, et al "Sudden death during the triathlon," JAMA 2010; 303: 1255-57.
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Related Article(s):
ACC: Triathletes More Likely to Die Suddenly Than Marathoners
Apparently his heart episode happened 8 minutes into the swim. This article says he did indeed have a long Q episode. I read somewhere else that he suffered from hypertension and probably had a heart attack. The stories don't jive.
LOUISVILLE, Ky. (WDRB) -- As Ironman athletes pack to leave Louisville with the satisfaction of completing another race, many of their thoughts are with the one who won't return home.
46-year-old Mark Wezka of Lancaster, New York suffered cardiac arrest and drowned during competition. His autopsy showed an underlying heart condition.
Ironman competitor Mike Manno explains, "It's so sad because this is sort of a health-conscious event. Everyone here eats right and trains hard and to hear of people actually dying during the event -- it's sad."
It happened during the 2.4 mile swim through the Ohio River -- the first, and what Manno calls the most intense, part of the triathlon: "When you jump into the water and people are hitting you, it's the hardest part of the race to just calm down and do your race and unfortunately it just seems to get people."
Unfortunately, dying during a triathlon is not unusual, but it turns out it almost always happens to triathletes during the swimming portion of the race. Thirteen of the 14 triathlon-linked deaths reported in the U.S. between 2006 and 2008 happened during the swim.
A study in the Journal of American Medical Association found these athletes twice as likely to die during competition than marathon runners. Cardiologist Dr. Rita Coram explains it's due to, "something called long QT syndrome, which is an innate abnormality in the electrical system of the heart cell....there's one type that is inherited and if one has it, they wouldn't know about it, but they do have a tendency to go into sudden cardiac death when they jump into cold water."
Another competitor, Manuel Sanchez, says, "it takes two to three weeks just to get the human system and whole body to re-energize."
Sixty-five competitors from the Louisville competition advance to the Ironman World Championship.
Racers say Wezka was part of a culture that you'd have live to understand. Competitor Mark Nelson says, "my heart goes out to his family, but this man died doing something he loved. You can't get any better than that."
Ironman is known as the most challenging of all triathlons, with a 140-mile course.
The swimmer probably had an unknown heart arrythmia such as a long Q interval. :( Perhaps everyone should get an ekg before participating in open water swimming.
It bothers me that swimming gets so much press for being a dangerous sport.
These triathlon swim deaths are extremely tragic and upsetting. As was the death of Fran Crippen. They definitely raise the question of how safety protocols can be improved.
But swimming is not a dangerous sport. Thirteen deaths in a 2-year period is a low number. Don't get me wrong--I wish with all my heart the number were zero. But I wonder how many triathletes died in car accidents during that time period.
I know a lot of people who have been in bad cycling accidents in the past year. None who have been in a swimming accident. But I see a lot more press on swimming accidents.
A few weeks ago, the Arizona Republic ran an article about the dangers of adults swimming alone. There was a spate of adult drownings. Mostly drunk people in hot tubs. All of the deaths had a medication or alcohol component. So the moral of that story is that I shouldn't go in the pool by myself? I'm a bazillion times safer swimming laps by myself than I am driving to the grocery store or, God forbid, cycling in traffic.
... everyone should get an ekg before participating in open water swimming....
In Italy is impossible do this kind of race without a complete EKG, after exhaustion. So...this kind of medical check is absolutely so far than an ironman race... if someone has physical problems maybe the Doctor can't find any
There has never been a time when I ventured out into open water (most of the time by myself) that the risks inherent in the sport were not on my mind. However, I must admit in a race I never think of it. Nevertheless, during my preparation for a race I always make sure my training addresses all of the possibilities (good & bad) that I might encounter in the race.
When I ride my bike on the road I am always thinking of what I would do when an approaching car "brushes" me off the highway. This has never stopped me from riding but it does spur me on to ride in rural areas. I also don't ride in the rain (unless I get caught out on a ride) because I don't like the risks. However, I am aware of the risks of descending out of the mountains at 40 to 50 mph as well. I understand the risks, and take them because I feel that my training and experience provide a base with which to minimizes the risk. But, as I quantify the risks and minimize them through experience and effort, I am also very aware that if something unexpected happens that it will result in a not insignificant injury.
Putting all of that aside, barring a massive heart attack, if a person has an attack on the road they may get beat up by the fall (or actually slow down enough they don't get injured), but there is a good chance someone will be able to get them to a hospital. It is a completely different scenario in open water. It's not swimming in open water that is risky, it's not carrying your cell phone, emergency floatation device and location beacon that is.
It bothers me that swimming gets so much press for being a dangerous sport.
These triathlon swim deaths are extremely tragic and upsetting. As was the death of Fran Crippen. They definitely raise the question of how safety protocols can be improved.
But swimming is not a dangerous sport. Thirteen deaths in a 2-year period is a low number. Don't get me wrong--I wish with all my heart the number were zero. But I wonder how many triathletes died in car accidents during that time period.
I know a lot of people who have been in bad cycling accidents in the past year. None who have been in a swimming accident. But I see a lot more press on swimming accidents.
A few weeks ago, the Arizona Republic ran an article about the dangers of adults swimming alone. There was a spate of adult drownings. Mostly drunk people in hot tubs. All of the deaths had a medication or alcohol component. So the moral of that story is that I shouldn't go in the pool by myself? I'm a bazillion times safer swimming laps by myself than I am driving to the grocery store or, God forbid, cycling in traffic.
Good point.I personally know of 3 people who have died biking on training rides.That seems much more dangerous than swimming.
We've talked about people dying during the swim. This weekend it happened during the bike. www.washingtonpost.com/.../gIQAaAwbLK_story.html
In the article they said the swim portion was cancelled due to rough water, so technically it was a BI-athelon.
One suspects that this gentleman may not have made it through the swim, had it been done.
I also have been hit on my bike,that turned into a hit & run! A lady got his lic. # & I had him arrested & his "high risk pool" ins. company paid big time for every bike repair that the shop could come up with!
Way to go Orca! I love it when the "Bad Guy" or gal gets caught!
In the article they said the swim portion was cancelled due to rough water, so technically it was a BI-athelon.
One suspects that this gentleman may not have made it through the swim, had it been done.
Would it be a BI or a DU? The swim was cancelled due to bacteria in the river.
