Incidence of Sudden Cardiac Death in National Collegiate Athletic Association Athletes.
Harmon KG, Asif IM, Klossner D, Drezner JA. Circulation. 2011 Apr 5. [Epub ahead of print]
On March 28th, we posted an article that suggested that mandatory screening for cardiac pathologies had no effect on reducing the risk of sudden death. That article, like many before it, used newspaper reports to find cases of sudden death among athletes. However, the accuracy of this technique is unclear. Therefore, the purposes of this study were to more precisely estimate the incidence of sudden cardiac death among NCAA athletes and assess the accuracy of traditional methods (for example, newspaper reports) for collecting data on sudden death. The study identified student athlete deaths between January 2004 and December 2008 via a NCAA database (using the NCAA Memorial Resolutions list and voluntary reports to the NCAA Director of Health and Safety) and the Parent Heart Watch database (based on weekly web searches related to sudden cardiac death cases). When possible the authors contacted the sports information director, head athletic trainers, athletic director, coroners, or parents/guardians. During the observation time there was 1,969,663 athlete-participation years and 273 deaths reported. The majority of deaths (68%) occurred on the playing field; including 140 accidents, 25 suicides, 18 homicides, and 5 drug overdoses. Cardiac deaths accounted for 45 deaths (16%; second only to accidents); therefore, the incidence of sudden cardiac death was 1:43,700 per year. The risk of sudden cardiac death was reported stratified by gender, sport, NCAA division, and ethnicity. Briefly, higher risk may be associated with males, blacks, basketball, or NCAA Division I participation (caution: the authors did not analyze these statistically and some data I am reporting may be influenced by other risk factors). The NCAA database identified 39 (of 45) sudden cardiac deaths, the newspapers detected 25 cases, and 9 were identified via catastrophic claims data. The authors conclude that sudden cardiac death is the leading cause of death during exercise among NCAA athletes. Furthermore, previous studies using newspaper reports or catastrophic claims data may be underestimating the risk of sudden cardiac death.
This study is important because it will influence health policy decisions and may influence the development of effective prevention strategies. Furthermore, if you check out the article you will see some interesting data; for example, the incidence among male Division I basketball players is 1:3,126. Furthermore, the data indicates that sudden cardiac death is almost 3 times more likely in blacks than in whites. Remember from the previous post that one concerns with mandatory testing was that you were looking for a needle in a very large haystack. They suggested that this would not be cost effective and would lead to false positives. These authors make an important contribution to the debate by suggesting that we should consider ECG screening for the highest-risk populations. This may be a nice compromise to the current debate. This is the type of data that we need as we talk with fellow clinicians and administrators about how we should proceed. This debate is far from over and much like the debates about managing concussions we must be engaged in the conversation.
Written by: Jeffrey Driban
Reviewed by: Stephen Thomas