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The Psychological Impact of Cardiovascular Screening in Young Athletes: Perspectives Across Age, Race, and Gender

Asif, Irfan M. MD*; Price, David MD; Harmon, Kimberly G. MD; Salerno, Jack C. MD§; Rao, Ashwin L. MD; Drezner, Jonathan A. MD

Clinical Journal of Sport Medicine: November 2015 - Volume 25 - Issue 6 - p 464–471
doi: 10.1097/JSM.0000000000000180
Original Research

Objective: To determine the psychological impact of electrocardiogram (ECG) screening in young competitive athletes based on age, race, and gender.

Design: Prospective multisite cross-sectional investigation.

Setting: Young competitive athletes.

Patients: One thousand five hundred six high school athletes (59.3% male with a mean age of 15.5 years, 56.2% white, 24.5% African American).

Independent Variables: Athletes underwent screening with a standardized American Heart Association-based history, physical examination, and ECG.

Main Outcome Measures: Prescreen and postscreen validated assessments for health attitudes, anxiety, and impact of screening on sport.

Results: Of the athletes participated, 76.3% had normal screens, 22.7% false-positive (FP) results (12.9% history, 4.2% examination, 3.1% ECG), and 0.9% were diagnosed with serious cardiac disorders. There were no differences in anxiety levels among athletes screening normal versus FP (P = 0.69). There was no difference in anxiety based on the reason for a FP result (history, physical examination, or ECG) both during (P = 0.95) and after (P = 0.40) screening. Analysis by age, race, and gender demonstrated that before screening, females were more likely to prefer knowing about underlying cardiac conditions compared with males (P < 0.001), and males were less concerned about having cardiac disease (P < 0.001) compared with females. African Americans were less concerned about underlying disease (P < 0.001) and less interested (P < 0.001) in cardiac screening compared with whites. Athletes diagnosed with a cardiac disease described anxiety after screening, but still believe that all athletes should receive an ECG before competition.

Conclusions: Electrocardiogram screening does not cause excessive anxiety in US high school athletes across spectrums of age, race, and gender. Recognition of age, race, and gender-specific perspectives could improve physician–patient dialogue and support mechanisms for those diagnosed with potentially lethal cardiac disorders.

Clinical Relevance: This article provides evidence that undue anxiety should not be used as an argument against the implementation of ECG screening during the preparticipation examinaton for young athletes. Although males and African Americans seem to be at highest risk for sudden cardiac death during exercise, they actually report being the least concerned and least worried about potentially harboring an underlying condition that might predispose them to such an event. Emotional support should readily be available for athletes who are diagnosed with cardiovascular conditions as these individuals report emotional distress after their diagnosis.

*Department of Family Medicine, Greenville Health System-University of South Carolina School of Medicine–Greenville, Greenville, South Carolina;

Department of Family Medicine, Carolinas Medical Center, Charlotte, North Carolina;

Department of Family Medicine, University of Washington, Seattle, Washington; and

§Division of Cardiology, Department of Pediatrics, University of Washington, Seattle, Washington.

Corresponding Author: Irfan M. Asif, MD, Department of Family Medicine, Greenville Health System-University of South Carolina Greenville School of Medicine, Greenville, SC 29605 (

Supported in part by the American Medical Society for Sports Medicine (AMSSM) Foundation Young Investigator's Research Grant.

The authors report no conflicts of interest.

Received April 24, 2014

Accepted September 29, 2014

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