Going into 2023, Damar Hamlin was a name that only Buffalo Bills and passionate football fans knew. But just two days into the new year, the whole country knew his name. On January 2, the 24-year-old suffered a sudden cardiac arrest on the field after making a tackle. About 10 minutes later, Hamlin was rushed off to a hospital in critical condition. Football fans around the world waited with bated breath hoping Damar would be okay until he was discharged nine days later.
Dr. Paul D. Thompson, MD., Fellow, American College of Sports Medicine and Chief of Cardiology, recently published a blog about commotio cordis, which he suggested as the likely cause of Hamlin’s cardiac arrest. As Dr. Thompson outlined, “There are several possible causes of Damar Hamlin’s cardiac arrest. Commotio cordis is the leading candidate but cardiac contusion, and even direct injury to the left anterior descending coronary artery are possible.”
Commotio cordis occurs from blunt trauma to the chest, delivered at a specific point in the cardiac cycle, which induces a dangerous, life-threatening heart arrhythmia or cardiac arrest.1 This healthcare condition is often described as “the perfect storm” due to the specificity of the heart’s vulnerability for it – about 30 milliseconds within the cardiac cycle.
A 1900-1910 report on baseball discovered 19 cases of commotio cordis due to baseball strikes to the heart. In 1996, almost a century later, the United States Commotio Cordis Registry was formed. As of 2018, about 220 cases had been reported in total. Studies show that commotio cordis typically occurs when there is impact from a small, dense object directly over the ventricle, such as a lacrosse ball or hockey puck. However, the condition can also result from a sharp blow to the chest, as was allegedly the case for Damar Hamlin.
However, there are many variables at hand. Gender, age, pliability of chest wall, genetics, location and object shape and velocity are all believed to be risk factors. According to Dr. Thompson’s textbook on Sports Cardiology, adolescent males between the ages of 11 and 19, with a median of 14, are most at risk for commotio cordis, due to teenagers’ flexible chest wall. Commotio cordis is also one of the most common causes of sudden cardiac death in young athletes. The success rate for resuscitation after commotio cordis is only about 60%, with early recognition and early automated external defibrillators (AED) being key for survival.2
Leveraging commercial claims data from Merative™ MarketScan® and our Treatment Pathways solution, we were able to research how often this condition surfaces in the general population. Out of almost 70 million patients from 2015 to April 2022, the analysis identified 210 patients with ICD-10 diagnosis codes (International Classification of Diseases) that may be attributed to commotio cordis (S2699XA and S2601XA*).
Here’s what the data tells us:
- Approximately 1 in every 3,000 may experience commotio cordis, demonstrating how rare the condition is
- Males accounted for 61% of incidents
- 50 years is the median age
- 46% of patients had an in-patient admission and 11% had an emergency room admission (most within one day of diagnosis)
It’s important to note that due to the challenges of recognizing commotio cordis, the diagnosis codes may not be complete or used as often or as accurately as they should be.
These MarketScan findings can help us expand our knowledge of commotio cordis, and other rare heart conditions, by looking at data representing the general population vs. primarily young athletes. Damar Hamlin’s condition making worldwide headlines resulted in increased awareness of cardiac arrest episodes and commotio cordis. That increase of awareness will hopefully result in improvements in the use of accurate diagnosis code sets for commotio cordis. The more accurate these claims codes are, the more precise the public health research will be.
Our MarketScan data provides a statistically accurate representative of the United States population and is leveraged in numerous ways to help researchers answer complex questions. See why leading organizations across the life science, payer, provider, government and academic fields are turning to MarketScan to make informed decisions driving healthcare forward for millions. MarketScan has the data you need to generate actionable insights and drive change in healthcare.
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* It’s important to note that sports-related commotio cordis does not have a specific ICD-10 code and these results reflect medical care for contusion of the heart and other unspecified injury of the heart regardless of etiology.
