Cardiac Arrest Risk Falls During Long Runs
Study of over 29 million US marathon and half-marathon runners shows stable cardiac arrest rates but sharp decline in fatalities.
Topline
Despite steady cardiac arrest rates in long-distance running over the past decade, deaths have dropped by nearly 50%, largely due to improved emergency action plans and access to defibrillators.
Study Details
With over 29.3 million race finishers between 2010 and 2023, this study from the Race Associated Cardiac Event Registry (RACER) investigated the incidence and outcomes of cardiac arrest during US marathons and half-marathons. It aimed to update trends since a prior analysis of races held from 2000 to 2009.
Notably, this newer study incorporated additional data sources including outreach to race directors, the USA Track & Field (USATF) incident claims database, and post-event survivor or family interviews.
Methodology
The researchers employed a prospective observational design using race data, media searches, and direct contact with participants. Confirmed cases of cardiac arrest—defined as pulseless unconscious collapse—were cataloged along with survivor outcomes, cause of arrest (when identifiable), and emergency response details. Sex, race distance, and pre-existing heart conditions were also tracked. Advanced tools such as molecular autopsy and genetic analysis were used in some decedent cases.
Key Findings
Stable Incidence: Cardiac arrests occurred in 176 runners (0.60 per 100,000 finishers), unchanged from prior decades.
Improved Survival: Fatality rate dropped from 71% (2000–2009) to 34% (2010–2023).
Most Common Cause: Coronary artery disease was the leading etiology, especially in older men.
Demographic Risk: Male marathon runners were the highest-risk group (1.8 cardiac arrests per 100,000).
AED Access Saves Lives: 100% of survivors received bystander CPR; most had access to defibrillators. Survival matched rates seen in AED-equipped settings like airports and casinos.
COVID Aftershock: Cardiac arrest incidence rose slightly in the post-2020 era, possibly due to decreased preventive care during the pandemic—not due to myocarditis.
Implications for Practice
🏃♂️ For Runners: Especially male marathoners over 40, this study underscores the need for proactive cardiovascular screening before race participation.
🩺 For Providers: Primary prevention of coronary artery disease in recreational athletes must be prioritized. Advise against stimulant use before races. Support AED deployment and CPR training for event staff and volunteers.
🚑 For Race Organizers: The evidence is clear—fast emergency response, bystander CPR, and AED availability drastically improve outcomes. Strategic placement of AEDs and trained personnel is essential for race safety.