SCA Shown to Strike Young Athletes Mostly During Training, Practice

Bystander cardiopulmonary resuscitation (CPR) and the use of an onsite automated external defibrillator (AED) greatly increase survival rates associated with sudden cardiac arrest (SCA) in young athletes — the leading cause of death in this group — according to over 20 years of new research data. Recent legislation and advocacy initiatives have aimed to increase cardiac safety in schools, but potential gaps remain in how resources are allocated and what preparedness models cover, the researchers said. “Most of the recent legislation is focused on schools, so we wanted to examine events that occur outside of schools and better understand what factors are influencing survival rates for young athletes,” said Bradley Petek, MD, Sports Cardiology Program, Oregon Health & Science University, Portland, Oregon, the lead author of the study published in the Journal of the American College of Cardiology: Advances. The observational study examined clinical characteristics, demographics, and emergency response efforts across young athletes who experienced SCA or sudden cardiac death (SCD) resulting from cardiomyopathy (CM). The researchers focused on inherited CMs because those cases make up a significant portion of these SCA and SCD events. Researchers found SCA and SCD occur in a wide age range of young athletes across sports. Their findings also showed that survivors of SCA were more likely to have a witnessed arrest (97.8% to 69.7%), receive bystander CPR (97.6% to 80.6%), and 72% of survivors had an onsite AED used compared to 16.2% of athletes with SCD. “The findings reinforce a fundamental principle in sudden cardiac arrest: Survival is highly dependent on the response during the first few minutes,” said Jalaj Garg, MD, a cardiologist at Loma Linda University Health in Loma Linda, California. “Although these observational data cannot establish causality, they reinforce the critical importance of rapid recognition, immediate CPR, and early defibrillation.” The research showed a sporting facility is where 67.4% of SCA and SCD events happened, and the vast majority of events occurred during practice or training, with 74.7% of cases compared to 25.3% during a game or competition. “These events happen across the age spectrum and they can happen anywhere,” Petek said. “People need to be ready to respond to them on any given day — in the weight room, at the gym, at any regular practice.” A Call to Action As awareness of CM-related SCA and SCD has increased, legislation and advocacy initiatives have followed. Recent efforts were designed to increase cardiac safety for young athletes and students. For example, the Cardiomyopathy Health Education, Awareness, and Research, and AED Training in Schools Act (H.R.6829) was signed into law in 2024 to require CM education and risk assessment in public schools and to support CPR and AED training. In 2023, the National Football League launched the Smart Heart Sports Coalition to improve emergency preparedness for young athletes, including AED access and CPR training for coaches. But the researchers identified gaps in these initiatives, as disparities exist across sports, school districts, and athletic venues, and many states have yet to fund these policies. The researchers hope this study can inform future policies and highlight opportunities for change, especially for expanding emergency preparedness beyond school campuses. “This study highlights a potential gap in a preparedness model that has traditionally focused heavily on schools and organized competition,” Garg said. “Cardiac emergency preparedness should follow the athlete, not the venue. Extending preparedness standards to community and public sporting facilities should therefore be an important public health and policy priority.” Study Details The study drew from the University of Washington National Collegiate Athletic Association Athlete Death database and the National Center for Catastrophic Sports Injury Research database. Researchers examined 742 cases of SCA and SCD over a 21-year pe rio d. Data included demographic information, sports participation, details from the SCA/SCD event, and media stories. Some events also included interviews with family members or event/school staff, medical history, hospital records, cardiovascular health information, and autopsy reports. The data included athletes aged 11 years or older who participated in middle school, high school, club, college, semiprofessional, or professional sports, as well as former athletes within 1 year of competition. CM was the underlying etiology of all cases in the study. The study showed 89% of athletes were male. Athletes with SCA and SCD secondary to hypertrophic cardiomyopathy (HCM) were more likely to be Black (51.9%) compared to arrhythmogenic cardiomyopathy (18.2%) and other CM (19.2%). Most events happened in high school (48.1%), followed by college (33.3%) and middle school (10.1%). Basketball was the most commonly involved sport (36.4%) followed by football (26.4%) and baseball (7.8%). Limitations included the likelihood of incomplete and biased data. Because there’s no mandatory reporting system for SCA/SCD in young athletes, the database probably didn’t capture every case in the US. It’s likely that events at homes and during informal sporting events are missing. And a number of cases didn’t include details about CPR responses, the use of an AED, or whether a young athlete underwent any medical screening prior to competition. The researchers hope this study can help inform efforts to improve response efforts to SCA and prevent SCD. “Sudden cardiac arrest in a young athlete is uncommon, but when it occurs it is time critical and potentially survivable,” Garg said. “We cannot predict every event, but we can build systems capable of responding immediately, regardless of where an athlete happens to be training or competing.” Petek’s Sports Cardiology Program reported receiving compensation for preparticipation cardiovascular screening for the National Hockey League Scouting Combine, University of Portland, and Portland State University. In addition, his Sports Cardiology Program reported receiving funding from the Joel Cornette Foundation for the Outcomes Registry for Cardiac Conditions in Athletes study. Emily Halnon is a freelance writer who lives in Eugene, Oregon. She covers science, health, and endurance sports for many outlets.