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Champs Fund
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"No young athlete should die from an undiagnosed heart condition"

Champs Fund (The Hicham El Hage Program for Young Hearts & Athletes Health) is a charitable fund established in April 2014 within the department of Family Medicine at the American University of Beirut Medical Center. The Fund is founded in memory of Hicham El Hage, a 15 year old young athlete who collapsed on  the  football  field  while  practicing  with  his  school  team  on  May  1,  2010  due  to  an undiagnosed hypertrophic cardiomyopathy.

The Fund aims at preventing sudden cardiac death in young athletes through advocating for mandatory cardiac screening of athletes, raising public awareness regarding cardiac risk in the young, and ensuring better preparedness  and  safety  of  the  sports  areas  through  the  availability  of  Automated  External Defibrillators (AEDs) & Cardiopulmonary resuscitation (CPR)-certified coaches.  

Sudden cardiac  arrest  is  the  leading  cause  of  death  among  young  athletes  (aged  12  to  35  years) worldwide. In the United Kingdom, 12 young people are reported to die suddenly every week and in the United States of America, one young person is reported to die every 2 to 3 days. Several international scientific societies and international sports organizations recommend conducting cardiac screening before enrollment in competitive sports. Moreover, prompt CPR and utilization of AED have been shown to improve  the  chance  of  survival  of  a  young  athlete  in  sudden  cardiac  arrest.  

Since its establishment, Champs Fund has been active at different levels in order to fulfill its mission. Activities were conducted at the level of advocacy, raising awareness, providing free cardiac screening and capacity building of relevant professionals. These activities are highlighted below:
 
  • ​An advocacy meeting with sports leagues and clubs in Lebanon in the presence of the Minister of Youth and Sports was held on August 29, 2014 where the need to make pre-participation exam mandatory for all athletes and ensure safe sports fields (trained coaches on performing CPR and having AEDs in the sports fields) was discussed. 

  • Training  of  30  doctors  from  different  primary  health  centers  in  Lebanon  on  performing  pre-participation exams and reading electrocardiogram (EKG) for athletes.

  • Launching a "Back to School Free Heart Screening" for young school and university students (aged 12-24 years) who play competitive sports. The screening was done over the period extending from September through end of November 2014 and covered more than 300 young athletes from different universities and schools in Lebanon. 

  • Conducting cardiac screening for athletes within the premises of their schools, universities and sports’ clubs.  This has improved accessibility to young athletes for cardiac screening.  The first screening was  conducted  in  Collège  Protestant  Français  in  Beirut;    plans  are  on  going  to cover other schools, universities and sports clubs in different regions in Lebanon. 

  • Training  of  sports  trainers/coaches  on  CPR  and  use  of  AEDs  in  collaboration  with  the  Life Support Center-Nursing Department-American University of Beirut Medical Center. Participants receive a Heartsaver certification for 2 years from the American Heart Association. Around 100 coaches received this training so far. 
 
Sudden Cardiac Death in Young Athletes 

Sudden cardiac death can unfortunately be the FIRST and ONLY presentation of an underlying heart condition in young athletes aged 12 to 35 years old.  The incidence of sudden cardiac death in young athletes has been estimated to be around 1-3 in 100,000 in different countries; and it is reported to be around 2.5 to 2.8 fold higher in young athletes as compared to age-matched non-athletes (2, 3).  

Sudden cardiac death due to cardiac disease did in fact affect several internationally renowned athletes over the years : Marathon runner Jim Fixx (1984), Olympic volleyball player, Flo Hyman (1986), former basketball  star,  Pete  Maravich  (1988),  college  basketball  star,  Hank  Gathers  (1990),  professional basketball  All-Star,  Reggie  Lewis  (1993),    Olympic  figure  skating  champion,  Sergei  Grinkov  (1995), football player, Marc Vivian Foe (2003), and football player, Miklos Feher (2004). Sports are not the direct cause of sudden death; yet, exercise triggers sudden death in athletes affected by cardiovascular conditions.  The  main  cardiovascular  conditions  causing  sudden  death  in  young competitive  athletes  aged  less  than  35  years  include  the  following:  Hypertrophic  cardiomyopathy, arrythmogenic right ventricular cardiomyopathy, congenital anomalies of coronary arteries, myocarditis, aortic rupture, valvular heart disease, pre-excitation syndromes and conduction diseases, ion channel disease and congenital heart disease .  Hypertrophic cardiomyopathy remains the leading cause of sudden death among athletes, and it is the most common form of heritable or genetic heart disease with a prevalence estimated at 0.2 % (i.e. 1 in 500 people) in the general population. 

Screening programs for pre-participation in competitive sports are endorsed by international societies: 
  • ​The  American  Heart  Association  recommends  using  a  health  questionnaire  and  a  physical examination when screening young athletes.

  • The  European  Society  of  Cardiology  and  major  international  sporting  bodies  (International Olympic  Committee  and  Federation  International  de  Football)  mandate  cardiac  screening  of athletes including an electrocardiogram (EKG).

  • In Italy, screening of participants in representative sports is mandatory. The screening program using an EKG, in addition to medical history and physical examination, has shown a significant reduction (89%) in the incidence of sudden cardiac death over a 25-year period.

  • The  inclusion  of  an  EKG  in  the  pre-participation  screening  for  prevention  of  sudden  cardiac death  in  young  athletes  was  found  to  improve  the  overall  sensitivity  of  pre-participation cardiovascular screening in athletes and to be cost-effective. 
 
It is important to note that it is possible to diagnose most of the cardiac abnormalities in young athletes and provide treatment options.  Treatment can include medical treatment, procedures, or the insertion of an implantable cardioverter defibrillator.  

Another important measure that needs to be taken into consideration to prevent sudden cardiac death is the use of AED and prompt CPR when faced with a person in sudden cardiac arrest. In fact, better survival rates have been reported in literature with the prompt use of defibrillation.  

References
  1. ​Corrado D, Basso C, Schiavon M, Pelliccia A, Thiene G.  Pre-participation  screening  of  young competitive  athletes  for  prevention  of  sudden  cardiac  death.  J  Am Coll Cardiol.  2008 Dec 9; 52(24): 1981-9.  2.  Wheeler  MT,  Heidenreich  PA,  Froelicher  VF,  Hlatky  MA,  Ashley  EA.

  2. Cost-Effectiveness  of Preparticipation  Screening  for  Prevention  of  Sudden  Cardiac  Death  in  Young  Athletes.  Ann. Intern. Med. 2010; 152: 276-286. 

  3. Corrado D, Basso C, Rizzoli G, Schiavon M, Thiene G. Does sports activity enhance the risk of Sudden death in adolescents and young adults. J Am Coll Cardiol 2003; 42:1959–63. 

  4. Koester M.  A  Review  of  Sudden  Cardiac  Death  in  Young  Athletes  and  Strategies  for Preparticipation Cardiovascular Screening. Journal of Athletic training 2001; 36(2): 197-204.  

  5. Corrado D, Basso C, Schiavon M, Pelliccia A, Thiene G. Does sports activity enhance the risk of sudden cardiac death? J Cardiovasc Med 2006; 7: 228-233.  

  6. Morita H, Larson MG, Barr SC, Vasan RS, O'Donnell CJ, Hirschhorn JN, Levy D, Corey D, Seidman CE, Seidman JG, Benjamin EJ: Single-gene mutations and increased left ventricular wall thickness in the community: the Framingham Heart Study. Circulation 2006, 113:2697-2705. 

  7. Maron BJ, Seidman CE, Ackerman MJ, Towbin JA, Maron MS, Ommen SR, Nishimura RA, Gersh BJ: How  should  hypertrophic  cardiomyopathy  be  classified?: What's  in  a  name Dilemmas in nomenclature characterizing hypertrophic cardiomyopathy and left ventricular hypertrophy. Circ Cardiovasc Genet 2009, 2:81-85; discussion 86. 

  8. Maron  BJ,  Thompson  PD,  Ackerman  MJ,  Balady  G,  Berger  S,  Cohen  D  et  al  (2007) Recommendations  and  considerations  related  to  preparticipation  screening  for  cardiovascular abnormalities in competitive athletes: 2007 update: a scientific  statement from the American Heart  Association  Council  on  Nutrition,  Physical  Activity,  and  Metabolism:  endorsed  by  the American College of Cardiology Foundation. Circulation 2007;  115:1643–1655

  9. Corrado D, Basso C, Pavei A, Michieli P, Schiavon M, Thiene G. Trends in sudden cardiovascular death  in  young  competitive  athletes  after  implementation  of  a  preparticipation    screening program. JAMA 2006; 296:1593–601.  

  10. Sharma S. Point/Mandatory ECG screening of young competitive athletes. Heart Rhythm Society 2012; 9: 1642-1645.  

  11. Baggish AL, Hutter AM Jr, Wang F, Yared K, Weiner RB, Kupperman E, Picard MH, Wood MJ. Cardiovascular  screening  in  college  athletes  with  and  without  electrocardiography:  A  cross-sectional study. Ann Intern Med. 2010 Mar 2; 152 (5):269-75. 

  12. Corrado D, Drezne Jr, Basso B, Pelliccia A, Gaetano TT. Strategies for the prevention of sudden cardiac death during sports.  European Journal of Cardiovascular Prevention & Rehabilitation 2011; 18: 197-208.

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