Measuring Sudden Cardiac Arrest and Death Incidence in Minnesota High School Athletes: A Comparison of Methodology and Implications for Prevention Strategies

Background The incidence of SCD in Minnesota high school athletes was recently reported from 1 in 416,666 to 917,069 athlete-years based on search of catastrophic insurance claims data. The low rate of SCD was attributed to the effectiveness of a standardized pre-participation screening program using American Heart Association recommendations. However, in college age populations insurance claims data identified only 20% of SCDs. Objective To determine the incidence of SCA/SCD in Minnesota high school athletes using media reports and compare this to incidence using insurance claims data. Design Retrospective review of the Parent Heart Watch database generated from systematic search of media reports. Each case was reviewed for details. Sport participation numbers were from the National Federation of High Schools. Setting Minnesota. Participants 1 906 014 high school athletes ages 14–18 from 2002–2012. Interventions None. Main outcome measurements Incidence of SCA. Results Media reports identified 14 SCAs, (7 SCDs /7 SCAs who survived), during the 10 year period examined, all in male athletes. The death rate in Minnesota high school athletes was 1 in 102 485. The SCA rate (death+arrests) was 1 in 51 243 athlete-years and 1 in 33 480 athlete-years in males. 43% of events and 29% of deaths identified occurred while participating on a school sponsored team. Seven of 14 events (50%) occurred in male basketball players for an SCA rate of 1 in 17 465 athlete-years. During the same time period there was one death (14%) identified using catastrophic insurance claims data. Conclusions SCA/SCD rates in Minnesota high school athletes are significantly higher than previously reported and the incidence in male basketball players is disproportionately high. Media reports have been shown to underestimate SCD rates by almost 50% so these numbers represent a low estimate. Insurance claims grossly underestimate the incidence of SCD and cannot be used to measure cardiovascular endpoints in athletes or evaluate screening programs.