Survival Outcomes After Sudden Cardiac Arrest in Young Competitive Athletes From the United States

Abstract

Background

Sudden cardiac arrest (SCA) is the leading cause of death among young competitive athletes during sports and exercise. A detailed analysis of survival outcomes should inform prevention strategies.

Objectives

The purpose of this study was to determine survival outcomes and trends following SCA among young competitive athletes in the United States and to explore outcomes based on race and exertional status.

Methods

This observational study identified cases of SCA among young competitive athletes through longitudinal surveillance by the National Center for Catastrophic Sports Injury Research from July 1, 2014, to June 30, 2023. Young athletes ≥11 years of age competing in middle school, high school, club, college, or semiprofessional/professional sports, and former athletes (within 1 year of participation) with SCA during exercise, rest, or sleep were included. The primary outcome was survival from SCA. Multivariable log binomial regression estimated survival proportion ratios by race and exertional status.

Results

A total of 641 athletes with SCA were identified during the 9-year study period (mean age 17 ± 3 years; 85% male). Overall survival was 49% (315 of 641). Survival from SCA occurring during exercise was 57% (275 of 481). The majority of cases were in high school athletes (61%), followed by college (15%) and middle school (12%) athletes. Overall survival (range 30%-66% per academic year; P = 0.007) and survival from exertional SCA (range 38%-72% per academic year; P = 0.03) both increased throughout the study period. Among exertional SCA events, survival was higher among athletes who experienced SCA during a game/competition vs practice/training (70% vs 53%; P = 0.001). Black race (RR: 0.63; 95% CI: 0.53-0.76), Other race (RR: 0.69; 95% CI: 0.50-0.94), and nonexertional SCA (RR: 0.43; 95% CI: 0.32-0.59) were associated with lower survival from SCA after adjusting for sex and level of competition.

Conclusions

Although survival from SCA among young competitive athletes in the United States has improved in the last decade, important racial disparities in outcomes were observed warranting additional research and prevention strategies.