Early in the COVID-19 pandemic, reports raised concerns that young infected or vaccinated athletes may be at high risk for sudden cardiac events, but research published this week in JAMA Network Open finds no evidence that they are.
Sudden cardiac arrest or death
Researchers in Brazil and the United States analyzed data from the National Center for Catastrophic Sports Injury Research at the University of North Carolina on rates of sudden cardiac arrest (SCA) and sudden cardiac death (SCD) before and during the COVID-19 pandemic (January 2017 to December 2022).
The study included competitive athletes at the youth, middle school, high school, club, college, and professional level who had an SCA or SCD during exercise, rest, or sleep.
The team defined SCA as an unexpected cardiac collapse in which cardiopulmonary resuscitation and/or defibrillation was given to an athlete who survived and SCD as 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.
An expert panel determined the cause of SCD using patient health records and previously published criteria.
"Many media and social media reports insinuated that COVID-19 illness or mRNA vaccines caused an increase in SCA/SCD in athletes," the researchers wrote.
Overestimating cardiac risk
A total of 387 athletes experienced SCA or SCD. The average age was 16.5 years, and 86.3% were male. The number of SCA/SCD events before and during the pandemic wasn't significantly different (203 vs 184), and 50.9% of affected athletes survived the event.
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.
The percentage of SCDs was similar before and during the pandemic (106 of 203 cases [52.2%] vs 84 of 184 cases [45.7%]). The expert panel determined a cause in 139 of 190 SCD cases (73.2%) using autopsy data or coroner reports, with myocarditis causing SCD in three athletes before and four during the pandemic. Myocarditis is inflammation of the heart muscle.
"This cohort study found no increase in SCA/SCD in young competitive athletes in the US during the COVID-19 pandemic, suggesting that reports asserting otherwise were overestimating the cardiovascular risk of COVID-19 infection, vaccination, and myocarditis," the study authors wrote. "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."
They noted that previous studies also found no link between out-of-hospital cardiac arrest and COVID-19 vaccination in young people or that COVID-19 vaccination increases the risk of SCA/SCD in athletes.
"Our study is limited by the potential for missed cases, variable participation during the pandemic, including a 2.5% decline in college athlete participation in 2020 to 2021, and incomplete data on causes," the researchers concluded. "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."
