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Etiology of sudden death in sports - also look beyond the heart!

Comment by Erik Ekker Solberg, EACPR Sports Cardiology Section

Ventricular Arrhythmias and Sudden Cardiac Death (SCD)

The cost-effectiveness of sport screening has been criticised. A way of improving efficacy of screening is a priori to identify high-risk individuals.
In a register of two million American college athletes, exertional sudden death in athletes with sickle cell trait (SCT) and cost-effectiveness of different screening models were explored. By reviewing all causes of sudden death in the period 2004-2008, the authors identified 273 deaths in a total of 1.9 million athlete-participant-years. In football, 20 deaths were due to medical causes; nine were cardiac, five were in athletes with SCT. Thirteen of the 20 deaths due to medical causes occurred during exertion; cardiac (6) and SCT-associated (5). All deaths associated with SCT occurred in black Division I football athletes. The risk of exertional death in Division I football players with SCT was 1:827 which was 37 times higher than in athletes without SCT. Screening only incoming athletes was cost-effective in all groups ($ 30/test), costing $2435 per year life saved (black football athletes) to $47 816 (all athletes).
Even when taken into account the small number of SCT-related deaths, exertional death in athletes with SCT occurs at a higher rate than previously expected.

This article expands the field of sudden death in sports and reminds us of other etiologies beyond the cardiac structure.