Sudden cardiac arrest survival rates up for young athletes, but racial disparities exist

Survival from sudden cardiac arrest has improved in young competitive athletes in recent years, but racial disparities in outcomes were observed, researchers reported.

Bradley J. Petek, MD, sports cardiologist and director of the Sports Cardiology Program at Oregon Health & Science University, and colleagues conducted an observational study of young competitive athletes who had sudden cardiac arrest and whose case was documented by the National Center for Catastrophic Sport Injury Research between July 2014 and June 2023. The results were presented at the American College of Cardiology Scientific Session and simultaneously published in the Journal of the American College of Cardiology.

“Previous studies have worked to define the incidence and etiologies of sudden cardiac arrest in competitive athletes to drive public policy to improved emergency cardiac preparedness through mandating emergency action plans, through improving CPR training and also through dissemination and use of [automated external defibrillators],” Petek said during a presentation. “As we have begun to accrue more data, we have been able to start assessing trends in sudden cardiac arrest and death in athletes over time. [In 2023] we presented a study that looked at all the sudden cardiac deaths in NCAA athletes over 20 years. It did not look at athletes with sudden cardiac arrest with survival. What we found was the incidence of sudden cardiac death decreased over the 20-year period. We hypothesized that this finding was because of improved cardiac emergency preparedness ... but we couldn’t prove that finding because we didn’t have any data on sudden cardiac arrest survival for athletes. That was the major impetus for the study today.”

The cohort consisted of 641 young athletes aged 11 years or older (mean age, 17 years; 85% male) who were competing in middle school, high school, club, college or semiprofessional/professional sport or had stopped competing within 1 year, and had sudden cardiac arrest during exercise, rest or sleep.

The primary outcome was survival from sudden cardiac arrest and the cohort was stratified by race and by exertional status at the time of the event.

The overall survival rate was 49% and the survival rate of athletes who had sudden cardiac arrest during exercise was 57%, Petek said during the presentation, noting the rate of survival of those whose event occurred at rest was 27%.

Sixty-one percent of the athletes were in high school, 15% were in college and 12% were in middle school, he said.

The range of survival rates during each academic year was 30% to 66% and the survival rate increased over time (P = .007), he said.

The range of survival rates from exertional sudden cardiac arrest during each academic year was 38% to 72% and increased over time (P = .03), according to the researchers.

Among those who had exertional sudden cardiac arrest, survival rates were higher for those whose event occurred in a game or competition compared with practice or training (70% vs. 53%; P = .001), Petek said.

After adjustment for sex and level of competition, compared with white athletes, Black athletes (adjusted RR = 0.63; 95% CI, 0.53-0.76; P < .0001) and athletes of other races (aRR = 0.69; 95% CI, 0.5-0.94; P = .02) were less likely to survive sudden cardiac arrest, whereas compared with those who had exertional sudden cardiac arrest, those whose event occurred during rest or sleep were less likely to survive (aRR = 0.43; 95% CI, 0.32-0.59; P < .0001), the researchers found.

Limitations include that cases could have been missed because there is no mandatory reporting system for sudden cardiac arrest in the U.S., that there was not robust data on variables such as bystander CPR and AED use and that athletes were identified by a single race category when some may identify with multiple categories, Petek said.

“We found significant racial disparities in survival outcomes in this study, and we believe this warrants further research in examining social determinants of health and resources for emergency preparedness to better understand these findings,” Petek said during the presentation. “Sudden cardiac arrest is a survivable event when you have emergency preparedness. We showed lower survival during practice and training settings compared to game and competition settings. This should be a clear priority to improve emergency preparedness in all settings where athletes participate in sports and train. It can’t just be at the stadiums. It has to be where they are practicing and training. We hope that this helps drive public policy around these topics.”