The overall survival rate of athletes who suffer sudden cardiac arrest has improved over the past decade, but the likelihood of surviving varies by race, where the cardiac arrest occurred and what athletes were doing when they collapsed, according to featured clinical research presented at the American College of Cardiology’s Annual Scientific Session (ACC.25) and simultaneously published in JACC.

More than 420,000 Americans experience an out-of-hospital sudden cardiac arrest every year, which occurs when the heart suddenly stops beating. It is different from a heart attack and can be caused by a variety of underlying and often undiagnosed heart conditions such as abnormalities in the shape or thickness of the heart muscle, arteries or valves. Sudden cardiac arrest can quickly result in death without immediate medical attention. Calling 911, starting cardiopulmonary resuscitation (CPR) and using an automated external defibrillator (AED) can greatly increase survival.

Sudden cardiac arrest is the leading medical cause of death in young athletes, and previous research has shown that Black athletes face a higher risk. This new study provides a contemporary assessment of rates of survival among different groups.

According to the results, 57% of Black athletes and 54% of other race (non-White, non-Black) athletes who suffered sudden cardiac arrest during exertion died between 2014-2023, compared with 32% of White athletes.

“It’s exciting that we’ve seen survival improve over the last decade, likely because of ongoing efforts to improve emergency preparedness including the recognition of sudden cardiac arrest and increases in AED distribution and CPR training,” said Bradley J. Petek, MD, a sports cardiologist at Oregon Health & Science University in Portland, Oregon, and the study’s first author. “However, the disparities that we see in survival, especially in athletes of Black race or other non-White, non-Black race, are important and warrant further research. Black athletes’ higher risk of having a sudden cardiac arrest coupled with a lower likelihood of survival is deeply troubling.”

The researchers analyzed 641 cases of sudden cardiac arrest that occurred in young athletes in the United States from 2014-2023. The cases were documented by the National Center for Catastrophic Sports Injury Research based on news and social media coverage along with several national databases. The athletes were on average 17 years old at the time they suffered sudden cardiac arrest, with the youngest being 11 years old and the oldest being 29 years old. Eighty-five percent of the affected athletes were male. Over 60% of the cases occurred in high school athletes, followed by college (15%) and middle school (12%).

Overall, 49% of the 641 athletes survived. About three-quarters of the cases occurred during exertion while the remainder occurred after exertion or during rest. Among the cases of sudden cardiac arrest that occurred during exertion, 68% of White athletes survived, while only 43% of Black athletes and 46% of those of other race survived. Survival rates varied from year to year but showed a general upward trend over the study period, with an overall survival rate of 48% in the 2014-2015 academic year and 72% in 2022-2023.

Although data on the use of CPR and AEDs were not available, the findings suggest that improved emergency preparedness (recognition of signs and symptoms, bystander CPR and AED use) likely played a role in survival. For example, survival was higher when the sudden cardiac arrest occurred during exertion rather than rest, presumably because such events were more likely to be witnessed by a bystander. Among cases that occurred during exertion, 70% survived when the athlete collapsed during a game or competition—which are typically held in facilities equipped with AEDs with many bystanders present—compared with 53% when the athlete collapsed during a training or practice.

The likelihood of survival also varied by sport. Survival rates were lowest for football (47%) and swimming (46%), which the researchers suggest could be attributable to the added time it takes for responders to begin CPR and use AEDs for such athletes, who may need to be cut free of protective padding in the case of football players or pulled out of the water in the case of swimmers. Petek said that these differences in outcomes underscore the importance of tailoring emergency training and preparedness efforts for particular sports and environments.

The on-field collapse and eventual recovery of NFL football player Damar Hamlin in 2023 brought national attention to sudden cardiac death in young athletes. In response, the NFL partnered with organizations, including the American College of Cardiology, to establish the Smart Heart Sports Coalition, which advocates for evidence-based policies and increased access to AEDs, CPR training and emergency action plans. Petek said that the study findings point to a need to build on this momentum.

“Hopefully this will lead to broader scale training on sudden cardiac arrest awareness, CPR training and AED distribution, because it can happen literally anywhere,” Petek said. “We need to broaden our lens beyond school and professional teams and well-resourced areas, and drive policy to try to improve emergency preparedness for all athletes in all locations.”

Since there is no mandatory reporting system for sudden cardiac arrest in young athletes, the dataset used in the study may not comprehensively reflect all cases that occurred during the study period, and some cases were missing data on details such as an athlete’s race, the underlying cause of the sudden cardiac arrest or whether CPR or an AED was used. Researchers said further studies could help to elucidate the factors that contribute to racial and other disparities and identify opportunities to improve outcomes.

This research is supported, in part, by the National Center for Catastrophic Sports Injury Research (NCCSIR), which receives support from the National Collegiate Athletic Association, the National Federation of State High School Associations, the National Athletic Trainers’ Association, the National Operating Committee on Standards for Athletic Equipment and the American Medical Society for Sports Medicine.

This study was simultaneously published online in JACC at the time of presentation.

For more information on Sudden Cardiac Arrest, visit CardioSmart.org/SuddenCardiacArrest.

ACC.25 will take place March 29-31, 2025, in Chicago, bringing together cardiologists and cardiovascular specialists from around the world to share the newest discoveries in treatment and prevention. Follow @ACCinTouch, @ACCMediaCenter and #ACC25 for the latest news from the meeting.

The American College of Cardiology (ACC) is the global leader in transforming cardiovascular care and improving heart health for all. As the preeminent source of professional medical education for the entire cardiovascular care team since 1949, ACC credentials cardiovascular professionals in over 140 countries who meet stringent qualifications and leads in the formation of health policy, standards and guidelines. Through its world-renowned family of JACC Journals, NCDR registries, ACC Accreditation Services, global network of Member Sections, CardioSmart patient resources and more, the College is committed to ensuring a world where science, knowledge and innovation optimize patient care and outcomes. Learn more at ACC.org.
###