No Spike in Cardiac Arrest Among Athletes During the Pandemic, Study Says

Despite concerns, there was no significant increase in sudden cardiac arrest (SCA) among young athletes during the COVID-19 pandemic, according to national surveillance data.

Comparing prepandemic and pandemic periods, the numbers of SCA and sudden cardiac death (SCD) logged in the UNC National Center for Catastrophic Sports Injury Research (NCCSIR) database were not significantly different (203 vs 184, P=0.33), reported Jonathan Drezner, MD, of the University of Washington in Seattle, and colleagues.

In the event of an SCA, the overall survival rate was 50.9%. SCDs occurred in 52.2% of cases before the pandemic versus 45.7% during the pandemic (P=0.20), the investigators noted in a research letter published in JAMA Network Open.

The findings from the surveillance program thus dispel some of the fears regarding COVID-19 illness or mRNA vaccines that cropped up during the early days of the pandemic.

A Look Back at Competitive Sports Disrupted During COVID-19

“This cohort study found no increase in SCA/SCD in young competitive athletes in the U.S. during the COVID-19 pandemic, suggesting that reports asserting otherwise were overestimating the cardiovascular risk of COVID-19 infection, vaccination, and myocarditis,” Drezner’s group wrote.

In the summer of 2020, collegiate sports were in turmoil over whether or not to proceed with the regular fall programs.

Preliminary cardiac MRI findings from that period were troubling. Researchers reported myocarditis in 15% of college athletes who tested positive for COVID-19, a big red flag, since heart inflammation can lead to SCA with exertion. Another group found widespread cardiac MRI abnormalities and myocardial inflammation after COVID-19 recovery.

Faced with these data, the National Collegiate Athletic Association (NCAA) Board of Governors directed each division to make a call on fall 2020 sport championships. Though multiple NCAA conferences announced they would go forward with the traditional fall championships, events that stayed on the calendar were often cancelled or postponed.

In 2021, a separate concern linking the COVID mRNA vaccines to myocarditis arose. The myocarditis signal has since been deemed legitimate after much probing, though researchers never found an actual uptick in SCD in young people who received vaccines.

“Many athlete cases shown in social media video montages occurred before the pandemic yet claimed COVID-19 infection or vaccination raised the risk of SCA/SCD,” Drezner and colleagues noted.

The most watched case of SCA in a young athlete was the televised collapse of then-24-year-old Damar Hamlin in January 2023. The NFL player’s doctors eventually came up with a diagnosis of cardiac arrest caused by commotio cordis, not myocarditis, nor a genetic heart condition.

The Hamlin incident occurred outside the period covered by the study from Drezner and colleagues.

Threat of COVID’s Cardiac Arrests Still Unfulfilled

For the present report, the investigators performed a prospective cohort study based on NCCSIR data from the 3 years before COVID-19 (2017 to 2019) and the first 3 years of the pandemic (2020 to 2022). Cases of SCA/SCD were recorded among competitive athletes from the youth, middle school, high school, club, college, or professional levels.

SCA was defined as an unexpected collapse in which cardiopulmonary resuscitation and/or defibrillation was provided in an individual who survived. SCD was defined as a sudden unexpected death due to a cardiac cause or a structurally normal heart with no other explanation for death and a history consistent with cardiac-related death.

Drezner’s group identified 387 SCA/SCD cases. Affected individuals had a mean age of 16.5 years (nearly 90% were ages 10 to 21), 86.3% were male, 56.3% were white, and 39.5% were Black. The activity level at the time of SCA was characterized as “during exercise” for 70%, and “at rest but awake” for 9.3%.

A specific cause could be determined in 73.2% of SCD cases using autopsy data or coroner reports.

Myocarditis was the confirmed cause of SCD in three and four cases, respectively, before and during the pandemic.

The study authors acknowledged the potential for missed cases from relying on the NCCSIR database. There was also a 2.5% decline in college athlete participation from 2020 to 2021.

“Although SCA/SCD in young athletes requires more robust preventive strategies, this study suggests the COVID-19 pandemic did not increase SCA/SCD risk in athletes,” Drezner and colleagues concluded.

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