People suffering heart attacks near major marathons face grimmer survival odds

April 12, 2017

People who suffer heart attacks or cardiac arrests in the vicinity of an ongoing major marathon are more likely to die within a month due to delays in transportation to nearby hospitals, according to newly published research from Harvard Medical School.

The delays, the researchers say, likely stem from widespread street closures during major races that can hamper transportation in an emergency.

Writing in the April 13 issue of the New England Journal of Medicine, the study authors call for citywide strategies that ensure unhampered access for medical crews in a certain radius of major races and other large public gatherings, such as sporting events or parades.

Previous studies have examined among marathon runners to assess the cardiac risks of endurance training, but this is believed to be the first study to analyze the impact of such races on those living nearby due to causes that have nothing to do with the physical exertion of running a marathon.

"We have traditionally focused medical preparedness and emergency care availability to address the needs of race runners, but our study suggests that effects of a marathon may spread well beyond the course of the event and affect those who live or happen to be nearby," said the study's senior author, Anupam Jena, the Ruth L. Newhouse Associate Professor of Health Care Policy at Harvard Medical School.

The investigators examined 10 years' worth of patient records analyzing death rates among older Americans, 65 years of age and over, within 30 days of having a heart attack or a near a major marathon across 11 U.S. cities. Researchers compared death rates among patients hospitalized on the day of the race with those hospitalized five weeks prior or five weeks after the race. Additionally, the researchers divided patients by zip code, comparing death rates among those living near the marathon and those living in zip codes well outside of the event's radius and unaffected by street closures.

Patients admitted to a hospital on race day were nearly 15 percent more likely to die within a month of suffering a heart attack or cardiac arrest compared with those admitted on a non-marathon day or in a hospital outside of the marathon's zip code(s).

That spike translated into a nearly 4 percent difference in the number of deaths. In other words, the researchers say, for every 100 patients with heart attack or cardiac arrest, three to four more people died within a month in the group admitted to a hospital on race day if they happened to go to a hospital near the race course.

The research also showed that ambulance transport was delayed by an average of 4.4 minutes on marathon days, 32 percent longer travel time compared with transports not delayed by marathons. Additionally, nearly a quarter of patients in the study got themselves to the hospital without an ambulance. While there is no record of the amount of time private transportation took, the authors suspect that many such trips would have been slow on marathon days.

The video will load shortly.
People who suffer heart attacks or cardiac arrests in the vicinity of an ongoing major marathon are more likely to die within a month due to delays in transportation to nearby hospitals, according to research from Harvard Medical School. Credit: Harvard Medical School

While the findings do not establish cause and effect between street closures and greater mortality, the researchers point out that many studies have shown that even very small delays in getting care could make the difference between life and death.

"When it comes to treating people in the throes of a heart attack, minutes do matter. Heart muscle dies quickly during a heart attack, so current guidelines call for rapid intervention, preferably within an hour or so of diagnosing a , to salvage cardiac muscle function," said Jena, who is also a physician at Massachusetts General Hospital.

As runners speed through the streets of the nation's most popular marathons, traffic around race routes slows to a crawl. Marathon organizers make every effort to ensure safe and smooth passage for runners, but large public gatherings—such as major sporting events, parades or Independence Day fireworks—can cause major traffic snags.

So, the HMS researchers wondered what kind of unintended consequences these sprawling, 26.2-mile events might have on the health of people who live near the race course.

The findings suggest that between three and four preventable deaths likely occur each year among older residents who suffer heart attacks and cardiac arrests during marathons across the eleven cities studied.

"Marathons and other large, popular civic events are an important part of the fabric of life in our big cities, and they bring people a lot of pride and joy," Jena said. "But the organizers of these events need to take these risks to heart when they are planning their events, and find better ways to make sure that the race's neighbors are able to receive the lifesaving care that they need quickly."

The races included in the analysis took place between 2002 and 2012 in Boston, Chicago, Honolulu, Houston, Los Angeles, Minneapolis, New York City, Orlando, Philadelphia, Seattle and Washington, D.C.

To rule out other possible explanations for the spike in mortality, the researchers checked to see whether patients were sent to different hospitals, whether they traveled longer distances, whether out of town spectators or race participants skewed the mix of patients, whether people waited until their conditions were more severe before calling for an ambulance, or whether staffing levels or the type of treatment used on days were different from usual, and they found no evidence to support any of these possibilities.

The researchers say that their findings suggest that citywide strategies for emergency medical preparedness need to do more to account for the risks to nonparticipants whose emergency medical care may be delayed.

"When cities host big marathons, or when people participate in races, they don't think that there might be a chance that a person not taking part in the could die because of the event," Jena said. "These findings don't mean we shouldn't have large public events, but hopefully our research will shine some light on the problem and suggest ways that planners can better provide for the health and safety of the people who live nearby."

Explore further: Marathon running may cause short-term kidney injury

Related Stories

Marathon running may cause short-term kidney injury

March 28, 2017
According to a new Yale-led study, the physical stress of running a marathon can cause short-term kidney injury. Although kidneys of the examined runners fully recovered within two days post-marathon, the study raises questions ...

Participating in marathons, half-marathons not found to increase risk of cardiac arrest

January 11, 2012
Participation in marathon and half-marathon races is at an all-time high, but numerous reports of race-related cardiac arrests have called the safety of this activity into question. A new study finds that participating in ...

Study focuses on heart health of AJC Peachtree Road Race runners

June 30, 2015
Researchers at the Emory University School of Medicine are teaming up with the Atlanta Track Club to study the effects of exercise on the heart.

Endurance runners more likely to die of heat stroke than heart condition

July 28, 2014
Heat stroke is 10 times more likely than cardiac events to be life-threatening for runners during endurance races in warm climates, according to a study published today in the Journal of the American College of Cardiology. ...

Differences in sex and running ability influence declines in marathon performance, study finds

February 28, 2017
A person's sex and running ability play a role in the decline of their performance in marathons as they get older, according to a Georgia State University study.

Recommended for you

How genes and environment interact to raise risk of congenital heart defects

October 19, 2017
Infants of mothers with diabetes have a three- to five-fold increased risk of congenital heart defects. Such developmental defects are likely caused by a combination of genetic and environmental factors. However, the molecular ...

Mouse studies shed light on how protein controls heart failure

October 18, 2017
A new study on two specially bred strains of mice has illuminated how abnormal addition of the chemical phosphate to a specific heart muscle protein may sabotage the way the protein behaves in a cell, and may damage the way ...

Newborns with trisomy 13 or 18 benefit from heart surgery, study finds

October 18, 2017
Heart surgery significantly decreases in-hospital mortality among infants with either of two genetic disorders that cause severe physical and intellectual disabilities, according to a new study by a researcher at the Stanford ...

Saving hearts after heart attacks: Overexpression of a gene enhances repair of dead muscle

October 17, 2017
University of Alabama at Birmingham biomedical engineers report a significant advance in efforts to repair a damaged heart after a heart attack, using grafted heart-muscle cells to create a repair patch. The key was overexpressing ...

Physically active white men at high risk for plaque buildup in arteries

October 17, 2017
White men who exercise at high levels are 86 percent more likely than people who exercise at low levels to experience a buildup of plaque in the heart arteries by middle age, a new study suggests.

High blood pressure linked to common heart valve disorder

October 17, 2017
For the first time, a strong link has been established between high blood pressure and the most common heart valve disorder in high-income countries, by new research from The George Institute for Global Health at the University ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.