SEX ONLY RARELY CAUSE CARDIAC ARREST

 Sexual activity is rarely the cause of sudden cardiac arrest, a new study suggests^[1].

Specifically, in more than 4500 cases of sudden cardiac arrest in adults living in Portland, OR in a recent decade, only 34 cases were related to sexual activity within the preceding hour.

Sexual-activity–related sudden cardiac arrest occurred in 32 men and two women. That is, one in 100 cardiac arrests in men and one in 1000 cardiac arrests in women were related to sexual activity, the researchers report.

The study by Dr Aapo Aro (Cedars-Sinai Heart Institute, Los Angeles, CA) and colleagues were presented as a poster on November 12, 2017 at the American Heart Association (AHA) 2017 Scientific Sessions and simultaneously published in a research letter in the Journal of the American College of Cardiology.

"These findings are reassuring" for clinicians and provide data to help inform discussions with patients, senior author Dr Sumeet S Chugh (Cedars-Sinai Medical Center) told theheart.org | Medscape Cardiology in an email.

Clinicians can now "base their reassurance to heart-disease patients across the spectrum on actual data," he said.

Even though the cases of sudden cardiac arrest were witnessed by the sexual partners, only a third of the individuals received bystander CPR from their partners, which may explain why only about one in five individuals survived until hospital discharge.

The findings reinforce the continued need "to educate the public on the importance of bystander CPR," the researchers note.

Clinicians have known for some time that the risk of cardiac arrest is low during sexual activity, but patients remain concerned and may not bring up the subject during a visit to their doctor, AHA spokesperson Dr Nieca Goldberg (NYU School of Medicine, New York) told theheart.org | Medscape Cardiology.

"Sexual activity is the equivalent of climbing two flights of stairs," she noted. Patients who have had heart surgery or a heart attack tell her that they are concerned about resuming sexual activity, often based on what they see in movies such as Something's Gotta Give, where Jack Nicholson has sexual-activity–related heart attack.

She says its important for clinicians as well as patients to make sure that a discussion about resuming sexual activity is a part of the predischarge educational package "and certainly in the first follow-up visit" after cardiac surgery or an MI, she said. "We really need to get the message out about learning how to do CPR."

Health and Mortality Benefits vs Risk of Arrest

Sexual activity is an important aspect of quality of life and brings health and mortality benefits; however, there is no information on sexual activity as a potential trigger for sudden cardiac arrest in the general population, Aro and colleagues write.

For this report, they analyzed data from individuals living in Portland who had a sudden cardiac arrest during 2002 to 2012 and were part of the Oregon Sudden Unexpected Death Study.

All cases were adjudicated, and the researchers also had information about the circumstances surrounding the cardiac arrest, the patient's medical records over a lifetime, and autopsy data.

On average, compared with the 4523 cases of other types of sudden cardiac arrest, the 34 patients who had sexual-activity–related cardiac arrest were younger (mean age 60 vs 65; age range 34–83) and more likely to be male (94% vs 68%) or African American (19% vs 8%).

Cardiac disease was similar in both groups: about 29% of patients had a history of coronary artery disease, 26% had symptomatic heart failure, and most were taking cardiovascular medications.

Compared with patients with other types of cardiac arrest, those with sexual-activity–related cardiac arrest were more likely to present with ventricular fibrillation or tachycardia (76% vs 45%; P<0 .001="" p="">

Survival was greater after sexual-activity–related cardiac arrest, but this was not significant (19% vs 13%, P=0.29) and was likely due to different rates of shockable rhythms.

The study shows the need to "increase awareness and education of CPR even in this awkward situation," Chugh said.

The study was funded by National Heart, Lung, and Blood Institute grants to Chugh. Chugh has received grants from Boston Scientific and Medtronic. Aro and the other coauthors have no relevant financial relationships.