Incidence and Etiology of Sudden Cardiac Arrest and Death in High School Athletes in the United States

Kimberly G. Harmon, Irfan M. Asif, Joseph Maleszewski, David S. Owens, Jordan M. Prutkin, Jack C. Salerno, Monica L. Zigman, Rachel Ellenbogen, Ashwin L. Rao, Michael John Ackerman, Jonathan A. Drezner

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22 Citations (Scopus)

Abstract

Objective To determine the incidence and etiology of sudden cardiac arrest and death (SCA/D) in US high school athletes. Patients and Methods A prospective media database of SCA/D was queried for cases aged 14 to 18 years from 7 states over 6 school years (September 1, 2007, to August 30, 2013). Event details were investigated to determine participation on a high school athletic team, sex, sport, and occurrence during school-sponsored activity or exertion. National sports participation numbers were used and a conversion factor was applied to account for multisport athletes. Autopsy reports were reviewed and cause of death was adjudicated by an expert panel. Results A total of 16,390,409 million athlete-seasons representing 6,974,640 athlete-years (AY) were examined, encompassing 36% of the total US high school athlete population. A total of 104 cases of SCA/D were identified (35 SCA with survival and 69 sudden cardiac deaths [SCDs]). The rate of SCD was 1:101,082 AY and of SCA/D 1:67,064 AY. Eighty-eight percent (92) of events occurred in male athletes. The rate of SCA/D in male athletes was 1:44,832 AY and in female athletes 1:237,510 AY (incidence rate ratio, 5.3; 95% CI, 2.9-10.6; P<.001). Men's basketball was the highest risk sport with an SCA/D incidence of 1:37,087 AY followed by men's football at 1:86,494 AY. Men's basketball and football athletes accounted for 57% (39) of deaths. Eighty percent of SCDs (55 of 69) were exertional and 55% (38 of 69) occurred while playing for a school-sponsored team. Autopsy reports were obtained in 73% (50) of cases. The most common findings of autopsy were idiopathic left ventricular hypertrophy or possible cardiomyopathy (13 of 50 [26%]), autopsy-negative sudden unexplained death (9 of 50 [18%]), hypertrophic cardiomyopathy (7 of 50 [14%]), and myocarditis (7 of 50 [14%]). Conclusion The rate of SCA/D in male high school athletes was 1:44,832 AY, with almost half due to possible or confirmed cardiomyopathy disease. It is likely that many cases were not identified because of reliance on media reports, and these numbers represent a minimum estimate.

Original languageEnglish (US)
Pages (from-to)1493-1502
Number of pages10
JournalMayo Clinic Proceedings
Volume91
Issue number11
DOIs
StatePublished - Nov 1 2016

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Sudden Cardiac Death
Athletes
Incidence
Sports
Autopsy
Basketball
Football
Cardiomyopathies
Hypertrophic Cardiomyopathy
Myocarditis
Left Ventricular Hypertrophy
Sudden Death

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Harmon, K. G., Asif, I. M., Maleszewski, J., Owens, D. S., Prutkin, J. M., Salerno, J. C., ... Drezner, J. A. (2016). Incidence and Etiology of Sudden Cardiac Arrest and Death in High School Athletes in the United States. Mayo Clinic Proceedings, 91(11), 1493-1502. https://doi.org/10.1016/j.mayocp.2016.07.021

Incidence and Etiology of Sudden Cardiac Arrest and Death in High School Athletes in the United States. / Harmon, Kimberly G.; Asif, Irfan M.; Maleszewski, Joseph; Owens, David S.; Prutkin, Jordan M.; Salerno, Jack C.; Zigman, Monica L.; Ellenbogen, Rachel; Rao, Ashwin L.; Ackerman, Michael John; Drezner, Jonathan A.

In: Mayo Clinic Proceedings, Vol. 91, No. 11, 01.11.2016, p. 1493-1502.

Research output: Contribution to journalArticle

Harmon, KG, Asif, IM, Maleszewski, J, Owens, DS, Prutkin, JM, Salerno, JC, Zigman, ML, Ellenbogen, R, Rao, AL, Ackerman, MJ & Drezner, JA 2016, 'Incidence and Etiology of Sudden Cardiac Arrest and Death in High School Athletes in the United States', Mayo Clinic Proceedings, vol. 91, no. 11, pp. 1493-1502. https://doi.org/10.1016/j.mayocp.2016.07.021
Harmon, Kimberly G. ; Asif, Irfan M. ; Maleszewski, Joseph ; Owens, David S. ; Prutkin, Jordan M. ; Salerno, Jack C. ; Zigman, Monica L. ; Ellenbogen, Rachel ; Rao, Ashwin L. ; Ackerman, Michael John ; Drezner, Jonathan A. / Incidence and Etiology of Sudden Cardiac Arrest and Death in High School Athletes in the United States. In: Mayo Clinic Proceedings. 2016 ; Vol. 91, No. 11. pp. 1493-1502.
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abstract = "Objective To determine the incidence and etiology of sudden cardiac arrest and death (SCA/D) in US high school athletes. Patients and Methods A prospective media database of SCA/D was queried for cases aged 14 to 18 years from 7 states over 6 school years (September 1, 2007, to August 30, 2013). Event details were investigated to determine participation on a high school athletic team, sex, sport, and occurrence during school-sponsored activity or exertion. National sports participation numbers were used and a conversion factor was applied to account for multisport athletes. Autopsy reports were reviewed and cause of death was adjudicated by an expert panel. Results A total of 16,390,409 million athlete-seasons representing 6,974,640 athlete-years (AY) were examined, encompassing 36{\%} of the total US high school athlete population. A total of 104 cases of SCA/D were identified (35 SCA with survival and 69 sudden cardiac deaths [SCDs]). The rate of SCD was 1:101,082 AY and of SCA/D 1:67,064 AY. Eighty-eight percent (92) of events occurred in male athletes. The rate of SCA/D in male athletes was 1:44,832 AY and in female athletes 1:237,510 AY (incidence rate ratio, 5.3; 95{\%} CI, 2.9-10.6; P<.001). Men's basketball was the highest risk sport with an SCA/D incidence of 1:37,087 AY followed by men's football at 1:86,494 AY. Men's basketball and football athletes accounted for 57{\%} (39) of deaths. Eighty percent of SCDs (55 of 69) were exertional and 55{\%} (38 of 69) occurred while playing for a school-sponsored team. Autopsy reports were obtained in 73{\%} (50) of cases. The most common findings of autopsy were idiopathic left ventricular hypertrophy or possible cardiomyopathy (13 of 50 [26{\%}]), autopsy-negative sudden unexplained death (9 of 50 [18{\%}]), hypertrophic cardiomyopathy (7 of 50 [14{\%}]), and myocarditis (7 of 50 [14{\%}]). Conclusion The rate of SCA/D in male high school athletes was 1:44,832 AY, with almost half due to possible or confirmed cardiomyopathy disease. It is likely that many cases were not identified because of reliance on media reports, and these numbers represent a minimum estimate.",
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AU - Asif, Irfan M.

AU - Maleszewski, Joseph

AU - Owens, David S.

AU - Prutkin, Jordan M.

AU - Salerno, Jack C.

AU - Zigman, Monica L.

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AU - Drezner, Jonathan A.

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N2 - Objective To determine the incidence and etiology of sudden cardiac arrest and death (SCA/D) in US high school athletes. Patients and Methods A prospective media database of SCA/D was queried for cases aged 14 to 18 years from 7 states over 6 school years (September 1, 2007, to August 30, 2013). Event details were investigated to determine participation on a high school athletic team, sex, sport, and occurrence during school-sponsored activity or exertion. National sports participation numbers were used and a conversion factor was applied to account for multisport athletes. Autopsy reports were reviewed and cause of death was adjudicated by an expert panel. Results A total of 16,390,409 million athlete-seasons representing 6,974,640 athlete-years (AY) were examined, encompassing 36% of the total US high school athlete population. A total of 104 cases of SCA/D were identified (35 SCA with survival and 69 sudden cardiac deaths [SCDs]). The rate of SCD was 1:101,082 AY and of SCA/D 1:67,064 AY. Eighty-eight percent (92) of events occurred in male athletes. The rate of SCA/D in male athletes was 1:44,832 AY and in female athletes 1:237,510 AY (incidence rate ratio, 5.3; 95% CI, 2.9-10.6; P<.001). Men's basketball was the highest risk sport with an SCA/D incidence of 1:37,087 AY followed by men's football at 1:86,494 AY. Men's basketball and football athletes accounted for 57% (39) of deaths. Eighty percent of SCDs (55 of 69) were exertional and 55% (38 of 69) occurred while playing for a school-sponsored team. Autopsy reports were obtained in 73% (50) of cases. The most common findings of autopsy were idiopathic left ventricular hypertrophy or possible cardiomyopathy (13 of 50 [26%]), autopsy-negative sudden unexplained death (9 of 50 [18%]), hypertrophic cardiomyopathy (7 of 50 [14%]), and myocarditis (7 of 50 [14%]). Conclusion The rate of SCA/D in male high school athletes was 1:44,832 AY, with almost half due to possible or confirmed cardiomyopathy disease. It is likely that many cases were not identified because of reliance on media reports, and these numbers represent a minimum estimate.

AB - Objective To determine the incidence and etiology of sudden cardiac arrest and death (SCA/D) in US high school athletes. Patients and Methods A prospective media database of SCA/D was queried for cases aged 14 to 18 years from 7 states over 6 school years (September 1, 2007, to August 30, 2013). Event details were investigated to determine participation on a high school athletic team, sex, sport, and occurrence during school-sponsored activity or exertion. National sports participation numbers were used and a conversion factor was applied to account for multisport athletes. Autopsy reports were reviewed and cause of death was adjudicated by an expert panel. Results A total of 16,390,409 million athlete-seasons representing 6,974,640 athlete-years (AY) were examined, encompassing 36% of the total US high school athlete population. A total of 104 cases of SCA/D were identified (35 SCA with survival and 69 sudden cardiac deaths [SCDs]). The rate of SCD was 1:101,082 AY and of SCA/D 1:67,064 AY. Eighty-eight percent (92) of events occurred in male athletes. The rate of SCA/D in male athletes was 1:44,832 AY and in female athletes 1:237,510 AY (incidence rate ratio, 5.3; 95% CI, 2.9-10.6; P<.001). Men's basketball was the highest risk sport with an SCA/D incidence of 1:37,087 AY followed by men's football at 1:86,494 AY. Men's basketball and football athletes accounted for 57% (39) of deaths. Eighty percent of SCDs (55 of 69) were exertional and 55% (38 of 69) occurred while playing for a school-sponsored team. Autopsy reports were obtained in 73% (50) of cases. The most common findings of autopsy were idiopathic left ventricular hypertrophy or possible cardiomyopathy (13 of 50 [26%]), autopsy-negative sudden unexplained death (9 of 50 [18%]), hypertrophic cardiomyopathy (7 of 50 [14%]), and myocarditis (7 of 50 [14%]). Conclusion The rate of SCA/D in male high school athletes was 1:44,832 AY, with almost half due to possible or confirmed cardiomyopathy disease. It is likely that many cases were not identified because of reliance on media reports, and these numbers represent a minimum estimate.

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