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Global incidence of sudden cardiac arrest in young athletes and military members: a systematic review and meta-analysis

Objectives: The goals of this review are to evaluate the quality of the evidence on epidemiology of SCA/D in athletes and military members; and to synthesize existing data to estimate annual incidence of SCA/D. Design: Systematic review and meta-analysis. Data Sources: MEDLINE, Embase, Cochrane CENTRAL, Web of Science, BIOSIS, Scopus, SPORT discus, PEDro, were searched from inception to date searched between 2/21/19 and 3/1/19, and Clinicaltrials.gov on 7/29/19. All databases were searched without limits on language. Eligibility for selecting studies: Studies which report incidence, or data from which incidence can be calculated, of SCA/D or both in athletes, or military members age 40. Results: 40 total studies were included. Overall quality of the evidence was judged to be poor. 35 of 40 included studies reported 1,902 events of SCD over 404,268,083 person years and a pooled incidence rate of 1.39events per 100,000 person years (95% CI: 0.80, 2.43) with high heterogeneity (I2=99%). 11 studies reported 219 events of SCA over 13,450,396 person years and a pooled incidence rate of 3.05 events per 100,000 person years (95% CI: 1.42, 6.58) with high heterogeneity (I2=96%). Conclusion: The worldwide incidence of sudden cardiac death and arrest in young otherwise healthy athletes and military personnel is low. Available subgroup analysis showed incidence rates were highest in males; military members, elite athletes; and soccer athletes. Findings are tempered by unexplained heterogeneity and risk of bias in included studies.