Despite decline in sudden cardiac deaths among athletes, Black and male players still at greater risk

New research reveals that while the rate of sudden cardiac deaths in college sports has decreased, it remains higher among Division I men's basketball players, as well as male and Black athletes in other sports. The study was published in Circulation, a journal from the American Heart Association, in late 2023.

Sudden cardiac death occurs when an electrical problem leads to a fast, irregular heartbeat that causes the heart to stop beating. It is the cause of roughly 300,000 to 450,000 deaths in the United States each year.

In a news release last year, the study’s lead author, Dr. Bradley J. Petek, attributed the 29% decline in sudden cardiac death rates every five years over the past 20 years to improved survival rates due to increased education on CPR, greater availability of automated external defibrillators (AEDs) and more comprehensive emergency action plans. "Or it may indicate improvements in pre-participation cardiovascular screening," he said. Petek is the director of sports cardiology at Oregon Health & Science University in Portland.

The heart of the matter

The study analyzed autopsy reports and medical histories of 1,102 NCAA athletes who died between July 2002 and June 2022. All athletes were at least 17 years old, with 78% being male. The researchers classified the causes of death into categories such as cardiac issues, cancer, suicide, heat stroke or unknown.

In 143 cases, the study identified sudden cardiac death as the cause, though not all occurred during physical activity. The most frequent heart-related causes were idiopathic left ventricular hypertrophy and possible cardiomyopathy — conditions affecting the heart muscle’s structure and function — and hypertrophic cardiomyopathy, characterized by a thickened heart muscle.

The research also linked eight deaths to myocarditis, an inflammation of the heart, and none to COVID-19 infection. Additionally, commotio cordis, a rare condition resulting from a blow to the chest, caused two sudden cardiac deaths. This condition was responsible for NFL player Damar Hamlin’s cardiac arrest during a "Monday Night Football" game in January 2023.

The analysis found that NCAA Division I men's basketball players, both Black and white, had the highest incidence rate of sudden cardiac death, with more than 1 in 2,000 experiencing it over a four-year collegiate career. However, across all sports, Black athletes were about three times more likely to suffer sudden cardiac death compared to white athletes, and men were approximately four times more likely than women. The sports with five or more reported sudden cardiac deaths during the study period included football, basketball, track and field, soccer, cross country, baseball and swimming.

What's missing: gaps and opportunities

This study has some limitations to consider. First, not all cases of sudden cardiac death may have been reported, possibly making the actual rate higher. The focus on NCAA athletes may only partially represent other young competitive athletes, and changes in sports medicine over the 20 years could affect the findings.

Differences in how the autopsies were done and reported also affected the accuracy of the results. Meanwhile, in 20% of cases, autopsies lacked enough evidence to determine the cause of a sudden cardiac death. In cases like these, genetic testing can help. Genetic testing can also help families understand their risk. However, postmortem genetic testing was only done on a few athletes.

Lastly, there was no data on resuscitated cardiac arrest or sudden cardiac death rates in non-athletic college students for comparison.

Said Petek: “We have the opportunity to greatly improve outcomes through ongoing training and education of CPR, providing better access to defibrillators and promoting the use and adherence to emergency action plans.”