Sports-related sudden cardiac death: Developing a valid and reliable screening tool

ABSTRACT Introduction: Although uncommon, sports-related sudden cardiac death (SSCD) can have catastrophic outcomes. Existing international screening tools, such as the American Heart Association-14 (AHA-14), participation physical evaluation-4 (PPE-4), Physical Activity Readiness Questionnaire, American College of Sports Medicine risk stratification, and Framingham Risk Score, are limited in their ability to detect risk factors relevant to diverse populations, particularly within the Arabian Gulf region. This research aims to develop and validate a comprehensive screening questionnaire for identifying individuals at increased risk of SSCD during physical activity. Methods: The questionnaire was developed through an integrative review of existing screening tools (e.g., AHA-14 and PPE-4) and refined based on input from an expert panel comprising cardiologists, exercise physiologists, and rehabilitation specialists. Construct and face validity were established using Exploratory Factor Analysis and Principal Component Analysis (PCA), and internal consistency was measured using Cronbach’s alpha. Results: The final questionnaire included 34 items organized across eight domains: (1) participant demographics, (2) exercise-induced symptoms, (3) family history of cardiovascular disease, (4) personal medical history, (5) cardiovascular risk symptoms, (6) current and past medication use, (7) use of supplements and performance enhancers, and (8) psychosocial and lifestyle factors. PCA analysis showed high agreement (≥0.790), and Cronbach’s alpha exceeded 0.70 for most domains, indicating acceptable internal consistency. The tool demonstrated utility in identifying individuals with potentially unrecognized cardiovascular risk. Conclusion: The developed screening questionnaire addresses key limitations of existing tools by incorporating region-specific and culturally relevant risk factors. It is suitable for implementation in sports clubs, fitness centers, and mass screening initiatives. Further validation is recommended to assess its predictive value and integration into regional health strategies.