Written by Ketan Patel
Spoon Feed
Sudden cardiac arrest (SCA) in athletes varies by age, sex, race and sport played; regardless of the factors, however, proper screening and emergency action plans are paramount in survivability. Recent trends support return to play post-SCA after individualized risk assessment and management in athletes.
When the fittest falter
Despite the perception that athletes are healthy, SCA affects them similarly to the general population. Understanding the incidence and etiology can allow those caring for athletes to optimize prevention, increase survivability, and give accurate and up-to-date advice on return to play after SCA.
This review is a narrative synthesis of population registries, autopsy series, and guideline statements surrounding factors of SCA in athletes. Key take-home points include:
- Incidence is higher in males and African American populations. Social determinants play a huge factor in survivability, with negative predictors being lower socioeconomic status and underrepresented racial and ethnic groups.
- Incidence is higher in men’s basketball, soccer, tackle football, ice hockey and cross-country running.
- Screening should include detailed histories, but also ECGs at a minimum on all athletes. For those 25 and younger, prioritize channelopathies and cardiomyopathies . In those over 25, pay special attention to coronary artery disease.
- Emergency action plans (EAP) are paramount in managing SCA when it occurs.
- Diagnostic evaluation following SCA should mirror non-athletes, led by medical professionals, with an expertise in sports medicine driving evaluation and return-to-play decisions. Recent data shows a growing body of evidence of safe return in those surviving SCA.
Limitations are plentiful: heterogenous observational data, variable case definitions, inconsistencies in reporting, and variable post-SCA evaluations. This limits generalizability and leaves the door wide open for future research.
How does this change my practice?
I am fortunate enough to cover athletes on the sidelines at various levels of competition, and this data supports the emphasis we place on EAPs and management of SCA if it were to occur. Universal and consistent screening, EAP implementation, and post-SCA care is something we should all advocate for in athletes at all levels of play.
Source
Sudden Cardiac Arrest in Athletes. N Engl J Med. 2026 Jan 15;394(3):268-280. doi: 10.1056/NEJMra2312555. PMID: 41534044.
