BMJ 2002;325:1439-1442 ( 21 December )

Admissions for myocardial infarction and World Cup football: database survey

Douglas Carroll, professor of applied psychology, ^a Shah Ebrahim, professor of epidemiology of ageing, ^c Kate Tilling, senior lecturer in medical statistics, ^d John Macleod, clinical research fellow, ^b George Davey Smith, professor of clinical epidemiology. ^d

^a School of Sport and Exercise Sciences, University of Birmingham, Birmingham B15 2TT, ^b Department of Primary Care and General Practice, University of Birmingham, ^c MRC Health Services Research Collaboration, Department of Social Medicine, University of Bristol, Bristol BS8 2PR, ^d Department of Social Medicine, University of Bristol

Correspondence to: G Davey Smith zetkin{at}bristol.ac.uk

Objectives: To examine hospital admissions for a range of diagnoses on days surrounding England's 1998 World Cup football matches.
Design: Analysis of hospital admissions obtained from English hospital episode statistics.
Setting: England.
Participants: Population aged 15-64 years.
Main outcome measures: Ratio of number of admissions for acute myocardial infarction, stroke, deliberate self harm, and road traffic injuries on the day of and five days after England's World Cup matches, compared with admissions at the same time in previous and following years and in the month preceding the tournament.
Results: Risk of admission for acute myocardial infarction increased by 25% on 30 June 1998 (the day England lost to Argentina in a penalty shoot-out) and the following two days. No excess admissions occurred for other diagnoses or on the days of the other England matches. The effect was the same when only the two days after the match were treated as the exposed condition. Individual analyses of the day of and the two days after the Argentina match showed 55 extra admissions for myocardial infarctions compared with the number expected.
Conclusion: The increase in admissions suggests that myocardial infarction can be triggered by emotional upset, such as watching your football team lose an important match.

What is already known on this topic Physical and emotional triggers, such as environmental disasters and vigorous physical exercise, can precipitate acute myocardial infarction An increase in cardiovascular mortality among Dutch men was associated with the 1996 European championship match between the Netherlands and France What this study adds Admissions for myocardial infarction increased on the day England was eliminated from the 1998 World Cup by Argentina in a penalty shoot-out and on the two subsequent days No effect was seen on admissions for other diagnoses or after other matches These data support the hypothesis that intense emotional reactions can trigger myocardial infarction

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