Sudden cardiac death in the athlete: bridging the gaps between evidence, policy, and practice

Sudden cardiac death (SCD) in a young athlete commonly brings to the forefront the many gaps in knowledge regarding how to predict and prevent these rare tragic events.1–3 Although the number of athletic sudden deaths is relatively small, with ≈100 to 150 competitive deaths during sports in the United States annually, they represent an important and emotionally charged public health issue, perhaps out of proportion to the relative risks of other pediatric deaths (Figure 1).1–5 Despite identification of the cardiovascular conditions that predispose to these events, much remains unknown regarding many fundamental issues related to athletic sudden death. The precise frequency with which these events occur in the United States remains unclear because of the absence of athletic death registries (and indeed any SCD registry) with mandatory reporting requirements.1–8 In fact, whether these events are more common in athletes is not at all certain. Additionally, significant gaps in evidence exist related to effectiveness of preventing sudden death in the athlete with preparticipation screening strategies. There are many limitations to the available evidence supporting the notion that athletic restriction improves outcomes. The effectiveness of cardiopulmonary resuscitation and automated external defibrillator (AED) programs, evident in casinos and airports, has not necessarily been shown in athletes.9 The ongoing debates related to prediction and prevention of athletic sudden death persists because the standards of evidence-based medicine have not been fulfilled with appropriately designed randomized controlled trials. Figure 1. Causes of death in the US population aged 1 to 21 years. Injury, homicide, and suicide dwarf the number of sudden deaths in athletes. SCD indicates sudden cardiac death. Data from the Centers for Disease Control and Prevention (http://webappa.cdc.gov/sasweb/ncipc/leadcaus10.html). On average, every 3 days in the United States a competitive athlete experiences a SCD, and many …