EDITOR’S NOTE: Lindsay Davis, a former Miss Ohio, is a youth sports health advocate, diagnosed with hypertrophic cardiomyopathy at age 17. She helped in the passage of “Lindsay’s Law” in the Ohio state legislature – a law that requires all coaches and teachers to undergo education on the symptoms of sudden cardiac arrest. She is currently working to get other states to pass a similar legislation in addition to a law that requires CPR training as a high school graduation requirement. She has previously written on these causes for USA Today HSS and is also associate editor of Open Heart BMJ, the online cardiology edition of the British Medical Journal.
While most of our basketball headlines this March have been inundated with Cinderella stories and coaching rivalries, there is one perpetrating a far more disconsolate tone.
Basketball fans attending the March 24th NBA G league Grand Rapids Drive game against the Long Island Nets thought they were in for a spirited game. But then the unthinkable happened: 26-year-old Zeke Upshaw, a 6-foot 6-inch player, collapsed on the court. Stunned fans later learned that he died of sudden cardiac arrest (SCA) — an electrical disturbance in the heart that causes it to suddenly stop beating.
Upshaw’s horrifically untimely death preceded Croatian soccer player Bruno Boban’s sudden cardiac death on the pitch just 2 days later and has pushed this topic to the forefront of social cognizance.
In the U.S., SCA affects an estimated 350,000 people annually according to the Sudden Cardiac Awareness Foundation, this number is almost equal to the amount of lives claimed by Alzheimer’s disease, assault with firearms, breast cancer, cervical cancer, colorectal cancer, diabetes, HIV, house fires, motor vehicle accidents, prostate cancer and suicide…combined.
A true paradox of sport is that in addition to the undisputed health benefits of physical activity, vigorous exertion may transiently increase the risk of cardiac events. SCA is the leading cause of death of student athletes. In fact, every three days, a young athlete somewhere in the United States collapses and dies due to an undetected heart problem. However, the rate of SCA in athletes that is cited in medical journals largely underestimates reality, mostly because the studies rely heavily on data from news reports. Even the most rigorous search of media reports and news outlets misses a lot of these cases.
While NBA and G league players receive some of the most comprehensive cardiac screening in elite sports in addition to 40% of the NCAA’s 4,511 basketball players receiving ECG screening, what are we doing to protect the 8 million high school athletes playing sports annually? We do not have a universal plan in place to protect these children.
Undiagnosed heart conditions can manifest a series of symptoms that are often consistent with common conditions associated with physical exertion and athletics such as shortness of breath, dizziness, extreme fatigue, syncope, and tachycardia (racing heart) making them ambiguous to the common athlete unaware the symptoms of heart disease. Of the deaths in student-athletes, 72% have previously reported having symptoms, according to the Journal of the American Board of Family Medicine. Often, those are not recognized as signs of a serious underlying condition simply because people are not being educated to look for the symptoms.
“Honestly, only when Jeff Green went through his heart issue did it really hit home to me. “ NBA Veteran Channing Frye said. “I was diagnosed with a heart issue the summer of 2012. I was feeling ‘fine’ except for some light dizziness when getting up. In my workouts I felt lethargic, and after my workout was done my heart would still be beating super fast.
“I think it is imperative to educate kids, coaches [and] parents nowadays about heart issues. The rigorous training and stress that young kids put on their body daily not including most kids don’t eat well enough to properly energize the self to support that kind of training. 100% anyone at the high school level or above should not only be educated but tested for heart issues”
Last fall Lindsay’s Law went into effect in Ohio. It aims to educate coaches, parents and athletes on the signs and symptoms of an underlying heart condition and requires a form to be signed in acknowledgment of them. In addition, a child exhibiting symptoms of heart disease is removed from play until cleared by a cardiologist. A version of this law has passed in 11 other states.
“Unfortunately, it is impossible to prevent sudden cardiac arrest in otherwise healthy individuals who are unaware that they have an underlying cardiac condition,” Dr. Dermot Phelan said. “There has been a long history of screening athletes in the United States for such conditions but even the best screening programs will fail to identify all who are at risk.”
Dr. Phelan is the official team cardiologist for the Cleveland Cavaliers, staff cardiologist and the Director of the Sports Cardiology Center at the Cleveland Clinic, and he also serves on the Cardiac Screening Advisory Committee for the National Basketball Association.
“The first step in the process is to educate people about the warning signs and symptoms of cardiac disease,” Dr. Phelan said. “Lindsay’s Law is a large step in the right direction – providing students, their families or guardians information about high-risk features to be aware of. This education also applies to team trainers and places an onus on them not to ignore signs or symptoms in young athletes that may be a harbinger of a terrible event. It is easy to seek an evaluation by a cardiologist and the results can be life saving.”
A number of states have begun acknowledging the importance of early intervention in the event of sudden cardiac arrest. Cardiopulmonary resuscitation – or CPR increases the chance of survival by 2 or 3 times when coupled with an automated external defibrillator (AED). CPR isn’t just performed to keep the heart beating; its most important function is to pump oxygenated blood around the body, which decreases the risk of the individual suffering brain damage. 38 states have made CPR and AED training compulsory for all high school seniors.
“There is no doubt that rapid response to SCA with early, effective CPR and defibrillation using an AED saves lives,” Dr. Phelan said. “Some studies show an increase in survival rates of up to 500% with bystander CPR. I have many athletes that I see in my clinic who are alive today because of rapid bystander intervention.”
Due to this, Frye sees the importance of being prepared.
“The fact that CPR and AED aren’t a mandatory class taught is astonishing to me,” Frye said. “Being able to correctly save a life when the situation arrives is more important than a couple of hours on a couple of Saturdays.”
Recently N.J. Congressman Frank Pallone proposed a national bill that streamlines and clarifies these current state laws that vary in style, substance, and interpretation making for a more efficient and refined law for entities across the country to comply with. H.R. 2243 The HEARTS Act requires the Secretary of HHS to coordinate with the CDC, patient advocacy and health professional organizations, in order to develop educational materials and resources on cardiomyopathy that will be distributed to schools, teachers and parents. It also calls for guidelines regarding the placement of life-saving AED’s in schools, as well as information on CPR training.
“All too often, otherwise healthy young people die suddenly from Sudden Cardiac Arrest – a silent killer that strikes 7,000 children a year,” Pallone said. “Raising awareness about the causes of Sudden Cardiac Arrest and ensuring schools are more prepared to deal with cardiac emergencies are the first steps in preventing these tragic deaths.”
Maybe you don’t have anecdotal experience with these tragedies, but devastating stories in the media are becoming frequent and the statistics are striking. Too many young, supremely conditioned athletes have already died too soon. Children are passing from treatable heart conditions and we need to do more to develop congruent policy across schools. You can do your part by letting your representatives (https://www.house.gov/representatives/find-your-representative) know that this issue matters. I encourage every citizen to contact their congressman/congresswoman so that they can champion The HEARTS Act in Congress.
Want to do even more?
H .R. 5013 The Cardiac Arrest Survival Act decouples the heterogeneous collection of state AED laws from Good Samaritan protections. The bill will help increase the survival rate from SCA by eliminating the threat of frivolous lawsuits through development of a nationally uniform baseline of protection for persons who use an AED while attempting to save a life during a medical emergency.
Dr. Jonathan Reiner, an avid proponent for the legislation, professor of medicine at of The George Washington University Hospital and Vice President Dick Chaney’s longtime cardiologist, told me every state has Good Samaritan laws.
“Unfortunately they are all different,” he said. “Some states immunize everyone. Some states only the AED owner. Some states only trained rescuers. There are training requirements. It’s a crazy quilt of regulations.”
Dr. Phelan went on to further discuss the importance of rapid resuscitation.
“Every effort needs to be made to ensure rapid resuscitation can take place, Dr. Phelan said. “Concerns about legal liability should not be a factor for a genuine person trying to save someone’s life. Expecting people to know what these laws are as they travel state to state is irrational and may inhibit people from acting.”
The new bill would make it so that if the AED is in good working order both the owner and rescuer are protected from any negligence claims.