The psychological impact of cardiovascular screening: the athlete's perspective.
BACKGROUND
Published guidelines suggest that ECG screening in US athletes may cause excessive anxiety, especially in those with false-positive findings. However, this has never been formally evaluated.


METHODS
Prospective, non-randomised controlled trial. High school athletes received a standardised history and physical examination (control) or a history and physical examination with an ECG (experimental). Prescreen and postscreen assessments for health attitudes, anxiety and impact of screening on sport were conducted.


RESULTS
952 athletes (49.7% girls, mean age 15.5 years) participated (control=150; experimental=802). 4.4% worried about having an underlying cardiac condition, and 73% wanted to learn if they had a cardiac abnormality prior to competition. In the experimental group, 576 had normal screens, 220 had an abnormal screen (by history 15.8%, physical examination 6.2% or ECG 1.7%) but normal work up (false-positive) and 6 were identified with a serious cardiac condition (true-positive, 0.75%). Compared with the control group, those who received an ECG were more likely to: (1) be significantly more satisfied with their screening (p<0.001), (2) feel safer during competition (p<0.01), (3) support that all athletes should receive cardiac screening (p<0.001) and (4) state the ECG positively impacted their training (p<0.001). False-positive athletes did not report anxiety during or after screening. Distress levels did not differ based on reason for needing further evaluation (history, physical examination or ECG, p=0.311). Compared with control participants, individuals with false-positive results: (1) reported no difference in postscreen anxiety (p=0.775), (2) felt safer during competition (p<0.001), (3) would recommend ECG screening to others (p<0.001) and (4) expressed a positive impact on training (p<0.001).


CONCLUSIONS
Excessive anxiety should not be used as a reason to forego ECG screening in athletes.
Department of Family Medicine, University of Tennessee, Knoxville, Tennessee, USA.
Irfan M
IM
Asif
Department of Family Medicine, University of Washington, Seattle, Washington, USA.
Serena
S
Johnson
Department of Family Medicine, University of Tennessee, Knoxville, Tennessee, USA.
Jason
J
Schmieg
Department of Family Medicine, University of Tennessee, Knoxville, Tennessee, USA.
Tiffany
T
Smith
Department of Family Medicine, University of Washington, Seattle, Washington, USA.
Ashwin L
AL
Rao
Department of Family Medicine, University of Washington, Seattle, Washington, USA.
Kimberly G
KG
Harmon
Division of Cardiology, Department of Pediatrics, University of Washington, Seattle, Washington, USA.
Jack C
JC
Salerno
Department of Family Medicine, University of Washington, Seattle, Washington, USA.
Jonathan A
JA
Drezner
D000293:Adolescent; D000704:Analysis of Variance; D001007:Anxiety / Q000209:etiology*; D056352:Athletes / Q000523:psychology*; D042241:Early Diagnosis; D004562:Electrocardiography / Q000523:psychology*; D005260:Female; D006331:Heart Diseases / Q000175:diagnosis* / Q000523:psychology; D006801:Humans; D008297:Male; D008487:Medical History Taking / Q000379:methods; D017060:Patient Satisfaction; D010808:Physical Examination / Q000379:methods; D011446:Prospective Studies
Cardiology; Cardiology prevention