Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Jan 9;149(2):80-90.
doi: 10.1161/CIRCULATIONAHA.123.065908. Epub 2023 Nov 13.

Sudden Cardiac Death in National Collegiate Athletic Association Athletes: A 20-Year Study

Bradley J Petek  1   2   3 , Timothy W Churchill  2   3 , Nathaniel Moulson  4 , Stephanie A Kliethermes  5 , Aaron L Baggish  2   3   6   7 , Jonathan A Drezner  8 , Manesh R Patel  9 , Michael J Ackerman  10   11   12 , Kristen L Kucera  13 , David M Siebert  8 , Lauren Salerno  8 , Monica Zigman Suchsland  8 , Irfan M Asif  14 , Joseph J Maleszewski  15 , Kimberly G Harmon  8
Affiliations

Sudden Cardiac Death in National Collegiate Athletic Association Athletes: A 20-Year Study

Bradley J Petek et al. Circulation. .

Abstract

Background: Understanding the incidence, causes, and trends of sudden cardiac death (SCD) among young competitive athletes is critical to inform preventive policies.

Methods: This study included National Collegiate Athletic Association athlete deaths during a 20-year time frame (July 1, 2002, through June 30, 2022). Athlete deaths were identified through 4 separate independent databases and search strategies (National Collegiate Athletic Association resolutions list, Parent Heart Watch database and media reports, National Center for Catastrophic Sports Injury Research database, and insurance claims). Autopsy reports and medical history were reviewed by an expert panel to adjudicate causes of SCD.

Results: A total of 143 SCD cases in National Collegiate Athletic Association athletes were identified from 1102 total deaths. The National Collegiate Athletic Association resolutions list identified 117 of 143 (82%), the Parent Heart Watch database or media reports identified 89 of 143 (62%), the National Center for Catastrophic Sports Injury Research database identified 63 of 143 (44%), and insurance claims identified 27 of 143 (19%) SCD cases. The overall incidence of SCD was 1:63 682 athlete-years (95% CI, 1:54 065-1:75 010). Incidence was higher in male athletes than in female athletes (1:43 348 [95% CI, 1:36 228-1:51 867] versus 1:164 504 [95% CI, 1:110 552-1:244 787] athlete-years, respectively) and Black athletes compared with White athletes (1:26 704 [1:20 417-1:34 925] versus 1:74 581 [1:60 247-1:92 326] athlete-years, respectively). The highest incidence of SCD was among Division I male basketball players (1:8188 [White, 1:5848; Black, 1:7696 athlete-years]). The incidence rate for SCD decreased over the study period (5-year incidence rate ratio, 0.71 [95% CI, 0.61-0.82]), whereas the rate of noncardiovascular deaths remained stable (5-year incidence rate ratio, 0.98 [95% CI, 0.94-1.04]). 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 (118 of 143). Eight cases of death were attributable to myocarditis over the study period (1 case from January 1, 2020, through June 30, 2022), with none attributed to COVID-19 infection. SCD events were exertional in 50% of cases. Exertional SCD was more common among those with coronary artery anomalies (100%) and arrhythmogenic cardiomyopathy (83%).

Conclusions: The incidence of SCD in college athletes has decreased. Male sex, Black race, and basketball are associated with a higher incidence of SCD.

Keywords: athletes; death, sudden, cardiac; exercise; sports.

PubMed Disclaimer

Conflict of interest statement

Disclosures Dr Ackerman is a consultant for Abbott, Boston Scientific, Bristol Myers Squibb, Daiichi Sankyo, Invitae, Medtronic, Tenaya Therapeutics, Thryv Therapeutics, and UpToDate. Dr Ackerman and Mayo Clinic are involved in an equity/royalty relationship with AliveCor, Anumana, ARMGO Pharma, and Pfizer. None of these entities was involved in this study. Dr Baggish has received funding from the National Institute of Health/National Heart, Lung, and Blood Institute, the National Football Players Association, the American Heart Association, and the American Medical Society for Sports Medicine to study cardiovascular outcomes among elite athletes and receives compensation for his role as team cardiologist from the US Olympic Committee/US Olympic Training Centers, US Soccer, and US Rowing. Dr Drezner has received funding from the American Medical Society for Sports Medicine, the American Heart Association, and the National Center for Catastrophic Sports Injury Research. Dr Harmon has received funding from the American Medical Society for Sports Medicine, Football Research, Inc, the Pac-12, and the American Heart Association. Dr Kucera is supported by funds from the National Center for Catastrophic Sports Injury Research.

Figures

Figure 1.
Figure 1.. Causes of Death Among NCAA Athletes (n=1102)
Definition of Abbreviations: SCT= sickle cell trait
Figure 2.
Figure 2.. Yearly Non-Cardiovascular Death and Sudden Cardiac Death Incidence among NCAA Athletes
Blue dots= Non-CV death yearly incidence rate, Blue line= cubic smoothing spline curve of Non-CV death incidence over study period Red dots= SCD death yearly incidence rate, Red line= cubic smoothing spline curve of SCD incidence over study period Definition of Abbreviations: AYs= athlete years, Non-CV= non-cardiovascular SCD= sudden cardiac death
Figure 3.
Figure 3.. Causes of Sudden Cardiac Death or Findings on Cardiac Autopsy Among NCAA Athletes (n=118)
Definition of Abbreviations: AC= arrhythmogenic cardiomyopathy, AN-SUD= autopsy negative sudden unexplained death, CAD= coronary artery disease, CM= cardiomyopathy, DCM= dilated cardiomyopathy, HCM= hypertrophic cardiomyopathy, NOS= not otherwise specified, SCD= sudden cardiac death, WPW= Wolff-Parkinson-White syndrome *Other= Long QT syndrome (1), complications of congenital heart disease (1), idiopathic LVH/possible SCT (1), Kawasaki’s disease (1), complications post-heart transplant (1), SCD in patient with pacemaker for idiopathic atrioventricular block (1)
Figure 4.
Figure 4.. Exertional Status at Time of Death by Common Causes of SCD
Definition of Abbreviations: AN-SUD= autopsy negative sudden unexplained death, CM= cardiomyopathy, LVH= left ventricular hypertrophy, NOS= not otherwise specified, SCD= sudden cardiac death
See this image and copyright information in PMC

Comment in

References

    1. Harmon KG, Asif IM, Maleszewski JJ, Owens DS, Prutkin JM, Salerno JC, Zigman ML, Ellenbogen R, Rao AL, Ackerman MJ, et al. Incidence, Cause, and Comparative Frequency of Sudden Cardiac Death in National Collegiate Athletic Association Athletes: A Decade in Review. Circulation. 2015;132:10–19. doi: 10.1161/CIRCULATIONAHA.115.015431 - DOI - PMC - PubMed
    1. Peterson DF, Kucera K, Thomas LC, Maleszewski J, Siebert D, Lopez-Anderson M, Zigman M, Schattenkerk J, Harmon KG, Drezner JA. Aetiology and incidence of sudden cardiac arrest and death in young competitive athletes in the USA: a 4-year prospective study. Br J Sports Med. 2021;55:1196–1203. doi: 10.1136/bjsports-2020-102666 - DOI - PMC - PubMed
    1. Malhotra A, Dhutia H, Finocchiaro G, Gati S, Beasley I, Clift P, Cowie C, Kenny A, Mayet J, Oxborough D, et al. Outcomes of Cardiac Screening in Adolescent Soccer Players. N Engl J Med. 2018;379:524–534. doi: 10.1056/NEJMoa1714719 - DOI - PubMed
    1. Toresdahl BG, Rao AL, Harmon KG, Drezner JA. Incidence of Sudden Cardiac Arrest in High School Student Athletes on School Campus. Heart Rhythm. 2014. doi: 10.1016/j.hrthm.2014.04.017 - DOI - PubMed
    1. Harmon KG, Asif IM, Maleszewski JJ, Owens DS, Prutkin JM, Salerno JC, Zigman ML, Ellenbogen R, Rao AL, Ackerman MJ, et al. Incidence and Etiology of Sudden Cardiac Arrest and Death in High School Athletes in the United States. Mayo Clin Proc. 2016;91:1493–1502. doi: 10.1016/j.mayocp.2016.07.021 - DOI - PubMed