Risk of cardiac events during the Super Bowl

While an increased risk of myocardial infarction (MI) has previously been reported with stressful European football/soccer matches, the association between American football matches and cardiac events remains largely unknown. The Super Bowl is considered the most important annual North American football match. In Canada, this event is frequently the most viewed television event each year. Viewers of the Super Bowl experience psychological stress and consume salty foods and alcohol, which may increase their risk of cardiac events. In this report, we assessed the association between the Super Bowl and cardiac events on a population-level. Population-based databases collected by the Canadian Institute for Health Information were employed to determine emergency department (ED) visits and hospitalizations for MI, heart failure (HF) and atrial fibrillation (AF) for 10 consecutive (2008–2017) Super Bowl weeks (Super Bowl Sunday and the six following weekdays) in Ontario, Canada. These datasets were linked using unique encoded identifiers and analyzed at ICES. The use of data in this project was authorized under section 45 of Ontario’s Personal Health Information Protection Act, which does not require individual consent or Research Ethics Board review. All Ontarians were included except those <18 and >80 years, or residing in a long-term care facility as they may not be exposed to behaviors associated with the Super Bowl. The mean incidence of each cardiac event on Super Bowl Sunday and each weekday following the Super Bowl during the study period was compared to the mean incidence of each cardiac event on the corresponding weekday in the week prior and subsequent to the Super Bowl to calculate the incidence rate ratio (IRR) and 95% confidence interval (CI). This approach allowed adjustment for known seasonal and weekday variations in cardiac events. A sensitivity analysis limiting the cohort to individuals <65 years was performed as the majority of Super Bowl viewers fall within this age group. Two-tailed P-values< 0.05 were considered significant. Analyses were performed with SAS software, version 9.4 (SAS Institute, Cary, NC, USA). The relative incidence of MI (IRR1⁄4 0.99; 95% CI, 0.90–1.09; P1⁄4 0.84), HF (IRR1⁄4 0.99; 95% CI, 0.86–1.13; P1⁄4 0.84) and AF (IRR1⁄4 1.01; 95% CI, 0.90–1.14; P1⁄4 0.81) was not statistically increased on Super Bowl Sunday compared to the prior and subsequent Sunday (Figure 1). On the Monday following the Super Bowl, an increased risk of MI (IRR1⁄4 1.09; 95% CI, 1.00–1.18; P1⁄4 0.04) was observed in the overall cohort. Among individuals< 65 years, the risk of MI (IRR1⁄4 1.12; 95% CI, 1.01–1.25; P1⁄4 0.037) and HF (IRR1⁄4 1.26; 95% CI, 1.04–1.53; P1⁄4 0.017) was also increased on the Monday following the Super Bowl. This study suggests the Super Bowl may lead to a small increase incidence of MI and HF. Excess MI risk on the Monday following the Super Bowl is not unexpected as the Super Bowl telecast traditionally ends late Sunday evening, and MI risk remains doubled even two hours after an emotional exposure. Excess HF risk observed Monday after the Super Bowl is also not unexpected because of the know delays in HF presentation. While the absence of an increased risk of AF may be considered surprising in light of the phenomenon of ‘‘Holiday Heart Syndrome’’, this finding is not completely unexpected as the largest prospective study to-date evaluating the effects of acute alcohol consumption and arrhythmia did not demonstrate an association between acute alcohol consumption and AF. These observations may be related to behaviors associated with the Super Bowl, which contribute to a hyperadrenergic state resulting in MI, or dietary indiscretion resulting in HF. While the overall increased risk of cardiac events is small, it is similar to that previously reported during a prior World Cup football tournemant. It is possible the magnitude of