April 5, 2011

Sudden Cardiac Death Affects 1 In 44,000 NCAA Athletes A Year

A new study states that one in 44,000 athletes in the National Collegiate Athletic Association has sudden cardiac death each year, higher than many estimates for young athletes in other areas, reports The Associated Press (AP).

The findings, published in Circulation: Journal of the American Heart Association, come on the heels of the death of a Michigan teenage basketball player who last month collapsed minutes after a game-winning shot, and could influence health screening guidelines for youths in organized sports.

According to the American Heart Association (AHA), training and competition in the athletic world can increase the risk of sudden cardiac death in people with underlying heart disease. A variety of heart conditions can be fatal for young athletes, including hypertrophic cardiomyopathy, an abnormal growth of heart muscle fibers.

Study author Kimberly Harmon, MD, a clinical professor at the University of Washington in Seattle, said that estimates on the number of cardiac deaths have often been based on inconsistent data sources such as media reports. Also, some studies lack solid evidence on how many young people play sports overall.

The new study relied on news reports, insurance claims and NCAA data. About 400,000 students between ages 17 and 23 participate in NCAA sports every year.

The study found that of medically-related deaths, 56 percent were cardiovascular-related sudden deaths. Of the 36 deaths that occurred during exertion, or shortly thereafter, 75 percent were related to cardiac causes. The study found that, overall, one in 43,770 athletes died annually of sudden cardiac death.

Harmon, a team physician at the University of Washington, said incidence rates often determine whether screening for athletes should include EKGs. "You have to revisit the whole question of whether a more extensive screening makes sense in light of these new numbers," she said. "The question is: where do you set the risk cutoff "” one in 10,000, or 40,000, or 100,000?"

"The question becomes, do we need to do a better job at finding who these kids are," said Harmon, who supports both college and high school athletes receiving EKG screening.

"I don't think that's all that rare," Dr. Jonathan Drezner of the University of Washington, a co-author of the study, told AP's Lauran Neergaard. "Young athletes are not supposed to die doing what they love."

The AHA recommends a thorough physical and detailed family and personal medical history for every athlete, but not an EKG. Doctors normally only order further cardiac testing with signs of fainting episodes, heart murmur or whether a relative died young of a heart-related illness.

Both the European Society of Cardiology and the International Olympic Committee recommend the addition of EKGs to pre-sports physicals.

Dr. Barry Maron of the Minneapolis Heart Institute Foundation, who helped develop AHA guidelines, says mandating EKGs, which can be very costly for the millions of US high school and college athletes, is not practical.

EKGs do not detect all problems that could lead to cardiac deaths, said Maron. The study couldn't tell the causes of players' deaths, only that they were heart-related. He said while sudden cardiac death is tragic, it's "just not that common" in young people.

Also, EKGs can often falsely signal a problem that requires further more costly testing to rule out. A study last year found that 16 percent of routine athlete EKGs were considered false positives.

Some US colleges have started recommending EKGs for all their athletes, and parent organizations also sponsor community screenings.

The University of Georgia gives incoming athletes both and EKG and a more costly echocardiogram, which can detect more problems than an EKG alone. The university finds that on average, one or two students per year have some abnormality detected, which are often treatable, according to sports medicine director Ron Courson, a spokesman for the National Athletic Trainers Association.

"The American Heart Association regards cardiovascular screening for athletes as an important public health issue, for which there are compelling ethical, legal and medical grounds," said Ralph L. Sacco, M.S., M.D., president of the American Heart Association, when interviews by Neergaard. "We strongly encourage student-athletes and other participants in organized competitive sports to be screened with a careful history, including family history, and thorough physical examination."

"The American Heart Association also believes healthcare professionals providing the screening should be able to order noninvasive testing when they judge it is needed," added Sacco.

Harmon said that more extensive screening might be practical if targeted at high-risk groups -- such as basketball players. Furthermore, automated external defibrillators -- used to revive people whose hearts have stopped -- could be placed in venues where those high-risk sports are played, she added.


On the Net: