Wednesday, October 28, 2009

Predicting Risk of Sudden Death in Marathon Runners

A Hypothetical Example of Disruptive Innovation and Predictive Modeling

Running is not an innocuous activity, even for veteran runners. Running does not convey immortality on its practitioners. Jim Fixx, author of The Complete Book of Running, died at 52 while running, and Dr. Richard Lillihei, a surgeon and fitness expert, dropped at 53 while running.

In the half Detroit Marathon recently, in which 8500 runners participated, three runners, all males, 65, 36, and 26, dropped dead. Earlier in the year, single deaths occurred in young man and young woman in their thirties in San Jose and in a 23 year male Virginia Beach halfmarathons. In the upcoming New York City marathon, the world’s largest, more than 100,000 runners will compete. Odds are, one or two of them won’t make it to the finish line because of sudden death.

In 2008 in the U.S, 425,000 ran in full marathons, and 745,000 in half marathons. Each year 4 to six marathon runners will collapse and die. Last year 7 died. The odds are 0.8 deaths per 100,000.

Could these deaths be predicted using disruptive innovation and predictive modeling? Disruptive innovation is offering specialized care in decentralized settings. Predictive modeling is a process by which a model is created to predict the probable outcome of something.

In the case of coronary artery disease, the usual cause of sudden death among runners, a clinical database of hundreds of thousands of people who have undergone cardiac stress testing is used to predict hospitalization or sudden death, given a set of known physiological variables.

According to the developers of SHAPE (System of Heart and Pulmonary Evaluation) medical systems, of St. Paul, Minnesota, the presence of early or advanced coronary artery disease can precisely be detected within a span of 6 minutes by using a simple portable SHAPE device – consisting of an electrocardiogram, a one step staircase, a snorkel like mouthpiece, a gas exchange analyzer, and a laptop containing a large database of previous individual who have undergone testing and whose clinical outcomes are known.

This testing has no risk since minimal exercise, stepping up and down on a staircase, or a six minute walk, is the only preparation. The SHAPE equipment is mobile, doesn’t require the presence of a cardiologist, and could easily be set up to test runners prior to a marathon or at the marathon site.

This is just a thought. To my knowledge, SHAPE has not been deployed before any marathon. But SHAPE lends itself to testing those to whom fitness is important, as personified by marathon runners.

For more information on SHAPE, see and these previous medinnovation blogs, July 24, 2009, “Testing for Cardiopulmonary Insufficiency in the General Population”, July 14, 2009, “Eureka! Measuring Physician Fitness to Bridge Gap Between Wellness and Sickness Systems of Care,” July 7, 2009, “A Treadmill Death”; June 1, 2008, “The 35th Innovation: Back of Track,” May 16, 2009,“Evidence Based Care,” The SHAPE of Things to Come,” April 28, 2009, “How to Contain the Coronary Artery Pandemic,” June 15, 2008, “Thoughts About Tim Russert and Heart Disease.” May 6, 2007.”On Preventing Heart and Lung Disease at the Same Time.”

Dr. Richard Reece is author, blogger, speaker, and innovation and reform commentator. Dr. Reece’s latest book, Obama, Doctors, and Health Reform ( is available at,, and for $31.95 (hardcover), $21.95 (softcover), and $6.95 (electronic). For information on speaking fees and arrangements, call 860-395-1501.

1 comment:

muebles las rozas said...

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