Watching soccer is not associated with an increase in cardiac events.

BACKGROUND: It remains controversial, whether spectators of soccer matches are exposed to an increased risk of cardiac events. In 2006, the Soccer World Cup (SWC) took place in Germany and provided an excellent opportunity to assess the effects of emotional stress on cardiac events in a large cohort of soccer enthusiasts in the region of Bavaria. METHODS: We analyzed data from the Bavarian Council for Statistics and Data Management for the period of SWC (June 9-July 9, 2006) and reference periods (SWCRef; May 1-July 31, 2005; May 1-June 8, 2006 and July 10-31, 2006) for the following diagnoses: myocardial infarction; myocardial re-infarction; cardiac arrest; paroxysmal tachycardia; atrial fibrillation, atrial flutter; all remaining tachyarrhythmias. Data were compared to the seven days during the tournament, on which the German team played (SWCGerman), the rest of the SWC period (i.e. the days the German team did not play, 24 days, SWCRest) and SWCRef (61 days). RESULTS: There was neither a significant increase (p>0.433) in total cardiac events in Bavaria per day during SWCGerman (161.1 ± 46.7) or SWCRest (170.5 ± 52.3) as compared to the SWCRef (176.2 ± 51.8), nor in any investigated diagnosis. After controlling for age, gender, loss of a match, outside temperature and nitric-dioxide air pollution levels the results remained essentially unchanged. CONCLUSION: Watching soccer was not associated with an increased incidence of cardiac events, regardless of whether the home team played or not. These data further support the hypothesis that spectators of sporting events are not exposed to an increased risk of cardiac events.

Mismatch between heart failure patients in clinical trials and the real world.

BACKGROUND: Evidence-based medicine urges physicians to translate results from clinical trials to their patients. This, however, can only work, if real world patients are represented in clinical trials. METHODS: We searched the literature on chronic heart failure (1950-2/2011) for studies designed to detect effects on mortality (mortality studies, MS) and exercise training studies (ETS) as the leading non-pharmaceutical/non-surgical treatment option in order to compare their characteristics with European (Euro Heart Survey on Heart Failure, EHSHF) and North American (Framingham Heart Study, FHS) epidemiological studies. RESULTS: After an extensive literature search, we identified 207 ETS and 59 MS. Subjects enrolled in ETS were younger (ETS: 62.5 ± 6.6; MS: 63.9 ± 4.6; EHSHF: 71.0 ± 3.5; FHS: 78.0 years), more often male (ETS: 80.9%; MS: 77.3%; EHSHF: 53.0%; FHS: 49.6%; p<0.001), and had substantially less comorbidities such as diabetes mellitus (ETS: 13.6%; MS: 22.5%; EHSHF: 27.0%; FHS: 25.3%; p<0.001), or hypertension (ETS: 26.3%; MS: 39.1%; EHSHF: 53.0%; FHS: 46.9%; p<0.001). Angiotensin converting enzyme-inhibitors, beta-blockers, and angiotensin-receptor-blockers were more commonly used in ETS than in EHSHF (all p<0.001). Only 16 (10.6%) ETS and 20 (62.5%) MS reported ethnic background. CONCLUSION: Heart failure patients in exercise training studies and mortality studies do not represent real world patients. In order to extrapolate data to the general population future exercise training studies as well as mortality studies need to include representative patients. Otherwise, knowledge gained can only be translated to a minority of our patients.