Accurate assessment of the incidence of sudden cardiac death (SCD) in athletes is necessary to shape appropriate strategies for its prevention. However, past estimates of SCD incidence vary widely and often utilise limited methodology for case identification.1 2

A recent study by Steinvil et al3 reports the incidence of SCD in Israeli athletes and claims that a mandated screening program including ECG has made no impact on the rate of SCD in athletes. The study received significant attention and has sparked further discord within the ‘ECG debate’. However, critical examination of the study methodology raises many concerns about the validity of the study conclusions.

Unfortunately, the science surrounding the incidence calculation in this study is significantly flawed. An accurate incidence calculation requires (1) a precise account of the number of SCD events during the study period (numerator) and (2) an accurate estimate of the population at risk (participating athletes per year – denominator). This study has neither.