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Sudden Cardiac Death in NCAA Athletes
Quick Takes
- The overall incidence of sudden cardiac death in NCAA athletes has decreased over the last 20 years.
- The sudden cardiac death rate remains highest among specific cohorts, including NCAA Division I Black and White basketball players with a risk of >1:2,000 over a 4-year college career.
- There were no cases of death attributable to COVID-19 myocarditis.
Study Questions:
What is the incidence, and what are the causes and trends of sudden cardiac death (SCD) in collegiate athletes?
Methods:
The study included National Collegiate Athletic Association (NCAA) deaths between July 1, 2002, and June 30, 2022. Four separate independent databases and search strategies were used to identify athlete deaths. Autopsy reports and medical history were reviewed by an expert panel to adjudicate causes of sudden death.
Results:
Of a total of 1,102 deaths, 143 cases of SCD were identified. The overall incidence of SCD was 1:63,682 athlete-years. Incidence was higher in male as compared with female athletes (1:43,348 vs. 1:36,228 athlete-years) and Black athletes as compared with White athletes (1:26,704 vs. 1:74,581 athlete-years). The highest incidence of SCD was among Division I male basketball players with an incidence of 1:8,188 athlete years (1:5,845 in Black athletes and 1:7,696 in White athletes). The incident rate for SCD decreased over the study period (5-year incident rate ratio, 0.71), while the rate of noncardiac deaths remained stable. Autopsy-negative sudden unexplained death (19.5%) was the most common postmortem examination finding, followed by idiopathic left ventricular hypertrophy or possible cardiomyopathy (16.9%), and hypertrophic cardiomyopathy (12.7%) in cases with enough information for adjudication. Eight deaths were attributable to myocarditis over the study period, with one case occurring during the coronavirus disease 2019 (COVID-19) era (January 1, 2020, to June 30, 2022), with none attributed to COVID-19 infection. SCD was exertional in 50% of cases. SCD was exertional in 100% of patients with congenital coronary anomalies and 83% of patients with arrhythmogenic cardiomyopathy.
Conclusions:
The authors conclude that the incidence of SCD in college athletes has decreased over the last 20 years. Black race and basketball are associated with a higher risk of SCD.
Perspective:
This study used a variety of databases to identify SCD among NCAA athletes over a 20-year period ending in 2022. The cause for declining rates of SCD over the study period is not entirely clear but may be related to improved screening or wider implementation of emergency action plans and automated external defibrillator availability to improve survival after sudden cardiac arrest. The study importantly showed no increase in SCD in the COVID era, specifically demonstrating no myocarditis-related deaths attributable to COVID-19 during this period. The high rate of autopsy-negative sudden unexplained death suggests the importance of post-mortem genetic testing when possible.
Clinical Topics: Arrhythmias and Clinical EP, Heart Failure and Cardiomyopathies, Sports and Exercise Cardiology, SCD/Ventricular Arrhythmias
Keywords: Athletes, Cardiomyopathies, Death, Sudden, Cardiac
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