Sudden Cardiac Death in NCAA Athletes | Journal Scan

Study Questions:

What are the incidence and causes of sudden cardiac death (SCD) among college athletes?

Methods:

Using participation, sex, and ethnicity data tracked by the National Collegiate Athletic Association (NCAA) for more than 450,000 student athletes annually, deaths in NCAA athletes were identified during the school years (July-June) from 2003-2004 to 2012-2013 using the NCAA Resolutions List, the Parent Heart Watch database, and NCAA insurance claims. Additional information and autopsy reports were obtained when possible. Causes of death were adjudicated by an expert panel.

Results:

There were 4,242,519 athlete-years and 514 total student athlete deaths. Accidents were the most common cause of death (257 [50%]; 1:16,508 athlete-years), followed by medical causes (147 [29%]; 1:28,861 athlete-years). The most common medical cause of death was SCD (79 [15%]; 1:53,703 athlete-years). Males were at higher risk than females (1:37,790 athlete-years vs. 1:121,593 athlete-years; incidence rate ratio [IRR], 3.2; 95% confidence interval [CI], 1.9-5.5; p < 0.00001), and black athletes were at higher risk than white athletes (1:21,491 athlete-years vs. 1:68,354 athlete-years; IRR, 3.2; 95% CI, 1.9-5.2; p < 0.00001). The incidence of SCD in Division 1 male basketball athletes was 1:5,200 athlete-years. The most common findings at autopsy were autopsy-negative sudden unexplained death in 16 (25%); followed by coronary artery anomaly (11%), coronary artery disease (9%), myocarditis (9%), and definitive evidence for hypertrophic cardiomyopathy (8%); with idiopathic left ventricular hypertrophy/possible cardiomyopathy and cardiomyopathy not otherwise specified in 8% each. Media reports identified more deaths in higher divisions (87%, 61%, and 44%), whereas percentages from the internal database did not vary (87%, 83%, and 89%). Insurance claims identified only 11% of SCDs.

Conclusions:

The rate of SCD in NCAA athletes is high, with males, black athletes, and basketball players at substantially higher risk. The most common finding at autopsy is autopsy-negative sudden unexplained death. Media reports are more likely to capture high profile deaths, whereas insurance claims are not a reliable method for case identification.

Perspective:

SCD in the athlete is a tragic event. Estimated rates of SCD in athletes range from 1:3,000 athlete-years in NCAA Division I basketball to 1:917,000 athlete-years in Minnesota high school athletes, a difference of over 300-fold. Data from this review confirm that specific populations of NCAA athletes appear to be at relatively increased risk. This review also sheds some light on how best to estimate the rate of SCD in student athletes, with substantial differences in rates of media reports based on the division of the school, and low rates of identification of SCD from insurance claims.

Clinical Topics: Arrhythmias and Clinical EP, Congenital Heart Disease and Pediatric Cardiology, Heart Failure and Cardiomyopathies, Sports and Exercise Cardiology, Atherosclerotic Disease (CAD/PAD), Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Congenital Heart Disease, CHD and Pediatrics and Arrhythmias, Sports and Exercise and Congenital Heart Disease and Pediatric Cardiology

Keywords: Accidents, Arrhythmias, Cardiac, Athletes, Autopsy, Basketball, Cardiomyopathies, Cardiomyopathy, Hypertrophic, Cause of Death, Coronary Artery Disease, Death, Sudden, Cardiac, Epidemiology, Heart Defects, Congenital, Hypertrophy, Left Ventricular, Incidence, Myocarditis, Pathology, Sports, Students


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