Survival After Exercise-Related Sudden Cardiac Arrest in Young Athletes: Can We Do Better?

Drezner, Jonathan A.; Peterson, Danielle F; Siebert, David M.; Thomas, Leah; Lopez-Anderson, Martha; Suchsland, Monica Z.; Harmon, Kimberly G.; Kucera, Kristen L.

doi:10.1177/1941738118799084

Cited by 57 publications

(55 citation statements)

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“…Indeed, survival from SCA is increasing with improved emergency response programmes and access to automated external defibrillators (AED). 14 A better understanding of the epidemiology of SCA/D in young athletes is needed to inform more effective and targeted prevention strategies. The purpose of this study was to determine the aetiology and incidence of SCA/D in USA competitive athletes through a comprehensive, prospective surveillance in collaboration with national centres.…”

Section: Introductionmentioning

confidence: 99%

Aetiology and incidence of sudden cardiac arrest and death in young competitive athletes in the USA: a 4-year prospective study

et al. 2020

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ObjectiveTo investigate the aetiology and incidence of sudden cardiac arrest and death (SCA/D) in US competitive athletes.MethodsProspective surveillance was conducted from 1 July 2014 to 30 June 2018 through the National Center for Catastrophic Sports Injury Research in collaboration with national sports organisations. Autopsy reports, death certificates, and medical records were reviewed by an expert panel to determine aetiology. Athlete participation statistics from the National Federation of State High School Associations and the National Collegiate Athletic Association (NCAA) were used to calculate incidence rates per athlete-years (AY). Comparisons of incidence rates were calculated using incidence rate ratios (IRR) with 95% CIs.Results331 cases of confirmed SCA/D (158 survivors; 173 fatalities) were identified; 15.4% in middle school, 61.6% in high school and 16.6% in college and professional athletes. Average age was 16.7 (11–29) years, and the majority were in male (83.7%), basketball (28.7%) or American football (25.4%) athletes. Common causes included hypertrophic cardiomyopathy (20.6%), idiopathic left ventricular hypertrophy (13.4%), coronary artery anomalies (12.0%) and autopsy-negative sudden unexplained death (9.6%). Coronary anomalies were more common in middle school athletes (28%), while cardiomyopathies (hypertrophic, arrhythmogenic, dilated, non-compaction or restricted) accounted for 47% of cases in college and professional athletes. Incidence was higher in male versus female athletes at the high school (1:43 932 AY (95% CI 1:38 101 to 1:50 907) vs 1:203 786 AY (95% CI 1:145 251 to 1:293 794); IRR 4.6 (95% CI 3.1 to 7.2)) and NCAA (1:34 906 AY (95% CI 1:25 385 to 1:49 173) vs 1:123 278 AY (95% CI 1:66 078 to 1:249 853); IRR 3.5 (95% CI 1.5 to 9.5)) levels. African American male NCAA Division I basketball players had the highest annual incidence rate of SCA/D (1:2087 AY (95% CI 1:1073 to 1:4 450)).ConclusionsCardiomyopathies account for nearly half of SCA/D cases in college and professional athletes, while coronary artery anomalies play a more prominent role than expected in middle school athletes. Over half of SCA cases in athletes result in sudden death, calling for improved prevention strategies.

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Section: Introductionmentioning

confidence: 99%

Aetiology and incidence of sudden cardiac arrest and death in young competitive athletes in the USA: a 4-year prospective study

et al. 2020

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“…Regarding survival after sudden cardiac arrest (SCA), Drezner et al 44 found that non-Hispanic/Latino White athletes had a higher survival rate than athletes from minority groups. This finding was supported by examinations of trends in disparities for pediatric mortality in SCA.…”

Section: Health Equity and Its Significance For Atsmentioning

confidence: 99%

“…El-Assad et al 45 assessed out-of hospital pediatric SCA deaths over 16 years and found that although mortality decreased over time in all racial and ethnic groups, non-Hispanic Blacks/African Americans had the highest mortality rate. Drezner et al 44 noted that this may have been due to minority patients' being less likely to receive bystander cardiopulmonary resuscitation and schools with fewer resources being less likely to have a cardiac response plan and an automated external defibrillator. 44 However, when an AT was present, 83% of athletes survived.…”

Section: Health Equity and Its Significance For Atsmentioning

confidence: 99%

“…Drezner et al 44 noted that this may have been due to minority patients' being less likely to receive bystander cardiopulmonary resuscitation and schools with fewer resources being less likely to have a cardiac response plan and an automated external defibrillator. 44 However, when an AT was present, 83% of athletes survived. 44 Survival after SCA underscores another key topic in the discussion of access to ATs: Are racial and ethnic disparities present in patterns of AT access and resultant health outcomes such as SCA survival rates?…”

Section: Health Equity and Its Significance For Atsmentioning

confidence: 99%

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“The Tip of the Iceberg”: Commentary on Sports, Health Inequity, and Trauma Exacerbated by COVID-19

Noel-London

Grimsley²,

Porter³

et al. 2020

Journal of Athletic Training

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Objective To discuss the relevance of system-level health inequities and their interplay with race in sports and athletic training, particularly during and after the coronavirus disease 2019 (COVID-19) pandemic. Background Health inequity is a systemic and longstanding concern with dire consequences that can have marked effects on the lives of minority patients. As a result of the unequal consequences of the COVID-19 pandemic, the magnitude of the outcomes from health inequity in all spheres of American health care is being brought to the fore. The discourse within athletic training practice and policy must shift to intentionally creating strategies that acknowledge and account for systemic health inequities in order to facilitate an informed, evidence-based, and safe return to sport within the new normal. Conclusions To continue to evolve the profession and solidify athletic trainers' role in public health spaces post–COVID-19, professionals at all levels of athletic training practice and policy must intentionally create strategies that acknowledge and account for not only the social determinants of health but also the effects of racism and childhood trauma on overall health and well-being.

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“…However, at the local high school level in the United States (US), several studies have identified a lack of overall compliance with safety standards related to exertional heat illness (EHI) prevention and treatment such as heat acclimatization and emergency action plans [ 16 , 17 , 18 , 19 , 20 , 21 ]. Conversely, when a policy is in place, it has been shown to be effective in improving patient outcomes following a catastrophic injury [ 22 , 23 , 24 ]. In the US, each state can set forth its own set of policy requirements for local high schools to follow.…”

Section: Introductionmentioning

confidence: 99%

Regional Requirements Influence Adoption of Exertional Heat Illness Preparedness Strategies in United States High Schools

et al. 2020

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Background and objectives: Exertional heat stroke (EHS) continues to be a prevalent health issue affecting all athletes, including our pediatric populations. The purpose of this study was to evaluate the effect of a state policy requirement for EHS prevention and treatment on local high school policy adoption in the United States (US). Materials and Methods: Athletic trainers (ATs) from high schools across the US participated in an online survey (n = 365). This survey inquired about their compliance with nine components of an EHS policy which was then compared to their state requirements for the policies. Evaluation of the number of components adopted between states with a requirement versus states without a requirement was conducted with a Wilcoxon Sign Rank test. Finally, an ordinal logistic regression with proportional odds ratios (OR) with 95% confidence intervals (CI) were run to determine the effect of a state requirement and regional differences on the number of components adopted. Results: ATs working in states with a requirement reported adoption of more components in their heat modification policy compared to states that did not require schools to develop a heat modification policy (with requirement mean = 5.34 ± 3.68, median = 7.0; without requirement mean = 4.23 ± 3.59, median = 5.0; Z = −14.88, p < 0.001). ATs working in region 3 (e.g., hotter regions) reported adopting more components than those in region 1 (e.g., cooler regions) (OR = 2.25, 95% CI: 1.215–4.201, p = 0.010). Conclusions: Our results demonstrate a positive association between state policy requirements and subsequently increased local policy adoption for EHS policies. Additionally, the results demonstrate that regional differences exist, calling for the need for reducing disparities across the US. These findings may imply that policy adoption is a multifactorial process; furthermore, additional regional specific investigations must be conducted to determine the true determinants of high school policy adoption rates for EHS policies.

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Survival After Exercise-Related Sudden Cardiac Arrest in Young Athletes: Can We Do Better?

Abstract: Public access defibrillator programs should be universal in schools and youth sporting venues and have the potential to increase survival after SCA in young athletes.

Cited by 57 publications

References 36 publications

Aetiology and incidence of sudden cardiac arrest and death in young competitive athletes in the USA: a 4-year prospective study

Aetiology and incidence of sudden cardiac arrest and death in young competitive athletes in the USA: a 4-year prospective study

“The Tip of the Iceberg”: Commentary on Sports, Health Inequity, and Trauma Exacerbated by COVID-19

Regional Requirements Influence Adoption of Exertional Heat Illness Preparedness Strategies in United States High Schools

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