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Incidence and outcomes of sudden cardiac death in athletes
Clinical Question
What is the incidence of sudden cardiac deaths in athletes, and what causes it?
Bottom line
Approximately 1 in 260 adolescent athletes had a disorder associated with cardiac death (DACD), and almost all were detected by the history, physical examination, and/or electrocardiography (ECG). Of 8 cardiac deaths in the population, 2 deaths were in patients who ignored advice not to compete, and 6 deaths (largely due to cardiomyopathy) were in athletes who had normal screening examination, ECG, and echocardiography results. Screening limited to the history, physical examination, and ECG will detect approximately 90% or more of athletes at risk for sudden cardiac death. 2b
Reference
Study design: Cohort (prospective)
Funding: Foundation
Setting: Population-based
Synopsis
As in many countries, the 92 clubs in the English Football Association (FA, as in the FA Cup for you footie fans) run academies for promising youth soccer players ages 15 to 17 years. At entry, they undergo a structured cardiovascular assessment to look for cardiovascular problems, including a subset classified as a DACD. Over a 20-year period, 11,168 athletes (95% boys) were screened with a history, physical examination, ECG, and echocardiography. A total of 820 athletes (7%) required further evaluation that could include exercise stress testing, 24-hour Holter monitoring, cardiac magnetic resonance imaging, or electrophysiology. The authors found that 42 athletes had a DACD (0.38%), most commonly Wolff-Parkinson-White syndrome (n = 26) or hypertrophic cardiomyopathy (n = 5). Another 225 (2%) had some other cardiovascular condition detected, most commonly bicuspid aortic valve, atrial septal defect, aortic regurgitation, mitral valve prolapse, or patent ductus arteriosus. Interestingly, while echocardiography was the test that most commonly detected an abnormality (237 of 267 total cardiac problems), ECG detected 36 of the 42 DACDs. In only 2 cases was echocardiogram the only abnormality when taking into account the history, physical examination, and ECG. Athletes with a DACD were advised to have it corrected if possible before return to play, and if that was not possible to no longer participate in athletics. During the roughly 118,000 person-years of follow-up, there were 8 sudden cardiac deaths. Two were in athletes with detected cardiomyopathy but who played anyway, 1 had a sudden arrhythmic death, and the other 5 had a cardiomyopathy that was either not present or not detected at the time of screening. The rate of sudden cardiac death was approximately 7 per 100,000 person-years, which is in the middle of the range found in other studies, though of course many high-risk athletes were identifed and excluded from participation. Although sudden cardiac death accounted for 35% of deaths in these athletes, motor vehicle accidents accounted for 30%, cancer for 22%, and drug overdose and suicide for 13%. The cost of screening was $342 per athlete, although the cost of echocardiography in this UK study was only $96, which is far lower than in the United States.
Reviewer
Mark H. Ebell, MD, MS
Professor
University of Georgia
Athens, GA
Comments
Very interesting that the cost of an EKG in the UK is $96 which is apparently much less than in the United States, whereas an EKG in Canada, funded by the Ministry of health in Ontario, is less than $15! It’s not that I think we should be charging more for EKGs in Canada, it’s just that I am very tired about hearing about the exorbitant costs of the healthcare system, where the per unit cost is dirt cheap, and the issue is more about utilization of an insured service (or, in many cases, overutilization)
Ability to play sports in thletes with DACD is as strongly defended as ability to drive is defended by patients with comparable disorders. In both groups independence is seriously threatened. The doctor-patient relationship is likewise threatened and must be met with honesty and empathy
Excellent
Screening teenage male athletes for DCAD
Helpful article about how to screen these athletes. It would have been nice to have some more female athletes would have been helpful.
Good information but both my wife and I were intrigued by the title. Can the authors really tell where we go after Death ???
When we talk about sudden cardiac death in athletes,hypertropic cardiomyopathy is common cause come to our mind. It is interesting know that wolff-parkinson-white syndrome is also common finding in them. Bicuspid aortic valve, arterial septal defect, aortic regurgitation are some of other causes for sudden cardiac death in athletes.
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