In our study, an increase of OHCA among the male population of the French speaking provinces of Switzerland during the FIFA 1998 World Cup was noted. Recent observations by Berthier and colleagues, based on analysis of death certificates (recorded in French death statistics system), showed a decrease in cardiovascular mortality in French men the day that France won the 1998 FIFA World Cup. This decrease was attributed to a reduction in stress because of the euphoria of victory.3
This study and a study completed by Toubiana and colleagues did not find an increase in French cardiovascular mortality during the 1996 European football championship; this difference may be explained by different methods of observation, because of the limited value of death certificates in the diagnosis of OHCA as previously reported.4,5
The similarities in geographical situation, behaviour, and diet between the populations of the French speaking provinces of Switzerland and France led us to suppose that our results could be also obtained in France if our study were replicated using MICU data. Although we cannot prove that all patients of our study who suffered from OHCA were football supporters, the increase in mental stress can contribute to an increase in sympathetic nervous system stimulation and circulating catecholamines, and induce a state of hypercoagulability. In addition, increased alcohol and tobacco consumption, a decrease in physical activity, and medical non-compliance during major sporting events, such as the FIFA World Cup, could contribute to an increase in the rate of sudden cardiac deaths among the male population of the French speaking provinces of our country. On the basis of our observations and of previous studies which focused on the impact of soccer competitions on cardiovascular mortality, we recommend that general practitioners inform their patients, and members of their families, of the risk of myocardial infarction and sudden cardiac death, and to observe medical compliance during major sporting events. The reinforcement of the emergency cardiac care system (increased number of emergency phone operators, physicians and paramedics on call) before major sporting events could also be suggested. The low incidence of shockable rhythms, despite short call to arrival intervals, should also be mentioned. In light of this fact, programmes which improve emergency communication systems and lower the threshold for calls to first responder must be implemented. More information about practical measures to adopt in case of chest pain or cardiac arrest must be provided to the general public via the media and physicians before major sporting events. The changes in AED deployment strategies and development of public access defibrillation are also expected to reduce the incidence of sudden cardiac death.