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Original research
Aetiology and incidence of sudden cardiac arrest and death in young competitive athletes in the USA: a 4-year prospective study
  1. Danielle F Peterson1,
  2. Kristen Kucera2,
  3. Leah Cox Thomas3,
  4. Joseph Maleszewski4,
  5. David Siebert5,
  6. Martha Lopez-Anderson6,
  7. Monica Zigman5,
  8. Jared Schattenkerk7,
  9. Kimberly G Harmon5,
  10. Jonathan A Drezner8
  1. 1 Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland, Oregon, USA
  2. 2 Department of Exercise & Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
  3. 3 Duke Cancer Institute, Duke Medicine, Durham, North Carolina, USA
  4. 4 Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
  5. 5 Family Medicine, University of Washington, Seattle, Washington, USA
  6. 6 Parent Heart Watch, Orlando, Florida, USA
  7. 7 University of Rochester School of Medicine & Dentistry, Rochester, New York, USA
  8. 8 Center for Sports Cardiology, University of Washington, Seattle, Washington, USA
  1. Correspondence to Dr Jonathan A Drezner, Sports Medicine Center, University of Washington, Seattle, WA 98195, USA; jdrezner{at}uw.edu

Abstract

Objective To investigate the aetiology and incidence of sudden cardiac arrest and death (SCA/D) in US competitive athletes.

Methods Prospective surveillance was conducted from 1 July 2014 to 30 June 2018 through the National Center for Catastrophic Sports Injury Research in collaboration with national sports organisations. Autopsy reports, death certificates, and medical records were reviewed by an expert panel to determine aetiology. Athlete participation statistics from the National Federation of State High School Associations and the National Collegiate Athletic Association (NCAA) were used to calculate incidence rates per athlete-years (AY). Comparisons of incidence rates were calculated using incidence rate ratios (IRR) with 95% CIs.

Results 331 cases of confirmed SCA/D (158 survivors; 173 fatalities) were identified; 15.4% in middle school, 61.6% in high school and 16.6% in college and professional athletes. Average age was 16.7 (11–29) years, and the majority were in male (83.7%), basketball (28.7%) or American football (25.4%) athletes. Common causes included hypertrophic cardiomyopathy (20.6%), idiopathic left ventricular hypertrophy (13.4%), coronary artery anomalies (12.0%) and autopsy-negative sudden unexplained death (9.6%). Coronary anomalies were more common in middle school athletes (28%), while cardiomyopathies (hypertrophic, arrhythmogenic, dilated, non-compaction or restricted) accounted for 47% of cases in college and professional athletes. Incidence was higher in male versus female athletes at the high school (1:43 932 AY (95% CI 1:38 101 to 1:50 907) vs 1:203 786 AY (95% CI 1:145 251 to 1:293 794); IRR 4.6 (95% CI 3.1 to 7.2)) and NCAA (1:34 906 AY (95% CI 1:25 385 to 1:49 173) vs 1:123 278 AY (95% CI 1:66 078 to 1:249 853); IRR 3.5 (95% CI 1.5 to 9.5)) levels. African American male NCAA Division I basketball players had the highest annual incidence rate of SCA/D (1:2087 AY (95% CI 1:1073 to 1:4 450)).

Conclusions Cardiomyopathies account for nearly half of SCA/D cases in college and professional athletes, while coronary artery anomalies play a more prominent role than expected in middle school athletes. Over half of SCA cases in athletes result in sudden death, calling for improved prevention strategies.

  • cardiovascular
  • cardiology
  • death
  • prevention

Data availability statement

All data relevant to the study are included in the article or uploaded as online supplemental information.

http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bjsports-2020-102666

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    Data availability statement

    All data relevant to the study are included in the article or uploaded as online supplemental information.

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    Footnotes

    • Twitter @DaveMSiebert, @DrKimHarmon, @DreznerJon

    • Correction notice This article has been corrected since it published Online First. The competing interests statement has been updated.

    • Contributors All authors were involved in data collection, analysis, writing and revision of the manuscript. All authors have approved the final version submitted.

    • Funding Supported by the National Center for Catastrophic Sports Injury Research (University of North Carolina at Chapel Hill), funded in part by the National Collegiate Athletic Association, the National Federation of State High School Associations, the American Football Coaches Association, the National Athletic Trainers’ Association, the National Operating Committee on Standards for Athletic Equipment, and the American Medical Society for Sports Medicine. DFP also received the Alpha Omega Alpha Carolyn L. Kuckein Student Research Fellowship for her work on this study.

    • Competing interests JAD is Deputy Editor of BJSM.

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

    • Provenance and peer review Not commissioned; externally peer reviewed.