November 1, 2024The Lancet
A contemporary review of sudden cardiac arrest and death in competitive and recreational athletes
Key result
Athlete SCA causes vary by age, linking genetics to youth and CAD to Masters athletes.
Why the study?
Sudden cardiac arrest and death in athletes are potentially preventable public health concerns, but precise incidence remains uncertain, racial disparities are unexplained, and primary prevention best practices remain controversial.
Key Points
- To review the epidemiology, age-dependent etiologies, disparities, and prevention strategies surrounding sudden cardiac arrest and death in competitive and recreational athletes.
- Synthesized contemporary evidence regarding the incidence, reporting infrastructure, and risk factors of sudden cardiac arrest and death across athletic populations.
- Evaluated the distinct underlying cardiac causes by age category and assessed primary versus secondary prevention frameworks.
- Etiology varies by age, with genetic conditions and unexplained normal autopsies predominant in young athletes, while coronary artery disease accounts for most cases in older Masters athletes.
- Significant racial disparities exist in outcomes between Black and White athletes, while true population-level incidence remains uncertain due to absent mandatory reporting systems.
- Primary prevention via preparticipation screening remains debated, but secondary prevention through structured emergency action plans is essential for cardiac safety.
Structured PICO
P
Population
Competitive and recreational athletes across all ages, sexes, and levels of competition
Limitations
- Lack of mandatory case reporting
- Lack of infrastructure to process all cases within the general population
- Unexplained disparities in outcomes between Black and White athletes
Key expert perspectives
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“To truly address these disparities, it's not enough to just screen for potential problems. There needs to be an understanding on how to tackle the underlying social determinants of health that puts these athletes at a greater risk.”
“We know that there is still a dramatic difference between male Black athletes and male white athletes. In fact, disparities among Black athletes compared to white athletes [are seen] across the board, with male Black athletes, basketball players, being at the highest risk, then female Black athletes. White male athletes are next and then [white] women at the bottom—they seem to be at the lowest risk.”
“This is about what happens every day and among schools in America. This is about the health of school aged children, and trying to understand that.”
Implication
This review highlights the uncertain incidence, age-dependent causes, and the critical importance of secondary prevention via emergency action plans for sudden cardiac arrest and death in athletes.
Abstract
Sudden cardiac arrest and death occur among competitive and recreational athletes across the entire spectrum of age, sex, and level of competition. These events are tragic, potentially preventable, and represent a global public health concern. Currently, the precise incidence of sudden cardiac arrest and death among all athletes is uncertain due to the lack of both mandatory case reporting and the infrastructure to process all cases that occur within the general population. Disparities in outcomes between Black and White athletes also exist without explanation. Causes of sudden cardiac arrest and death are age-dependent, with genetic heart conditions and unexplained cases (ie, normal autopsy) predominant among younger athletes, and coronary artery disease accounting for most cases among veteran Masters athletes. Determining best practices for prevention of primary sudden cardiac arrest and death, including preparticipation screening, remains controversial. However, secondary prevention grounded in an emergency action plan incontrovertibly represents a fundamental aspect of comprehensive cardiac care for all athletes.
Coverage & sources
Journal, society, and media accounts. Useful signal, not independent expert judgment.
Discussion
No takes yet. Share an insight, caveat, or question.
Cite This Study
Kim et al. (2024) conducted a review in Sudden cardiac arrest and death in competitive and recreational athletes. Causes of sudden cardiac arrest and death in athletes are age-dependent, with genetic conditions predominant in younger athletes and coronary artery disease in veteran Masters athletes.