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Psychological impact of electrocardiogram screening in National Collegiate Athletic Association athletes
  1. Irfan M Asif1,
  2. Scott Annett1,
  3. Joseph A Ewing1,
  4. Ramy Abdelfattah2,
  5. Brittan Sutphin3,
  6. Kyle Conley3,
  7. Justin Rothmier3,
  8. Kimberly G Harmon3,
  9. Jonathan A Drezner3
  1. 1 Greenville Health System-University of South Carolina School of Medicine, Greenville, USA
  2. 2 Stanford University, Palo Alto, USA
  3. 3 Department of Family Medicine, University of Washington, Washington, USA
  1. Correspondence to Dr Irfan M Asif, Department of Family Medicine, Greenville Health System- University of South Carolina Greenville School of Medicine, Greenville, SC 29605, South Carolina; IAsif{at}sc.edu, irf7{at}hotmail.com

Abstract

Purpose Determine the psychological impact of false-positive ECG screening in National Collegiate Athletic Association (NCAA) athletes.

Methods Athletes representing seven NCAA institutions received a standardised history, physical examination and ECG interpreted using the 2013 Seattle Criteria. Assessments of health attitudes, anxiety and impact of screening on sport were conducted using validated prescreen and postscreen measurements.

Results 1192 student-athletes participated (55.4% male, median age 19 years, 80.4% Caucasian). 96.8% of athletes had a normal cardiovascular screen, 2.9% had a false-positive ECG and 0.3% were diagnosed with a serious cardiac condition. Prior to screening, 4.5% worried about potentially harbouring cardiac disease and 70.1% preferred knowing about an underlying condition, rather than play sports without this knowledge. There was no difference in anxiety described by athletes with a normal versus false-positive screen (p=0.369). Reported anxiety levels during screening also did not differ when analysed by different gender, race, division of play or sport. Athletes with normal and false-positive screens had similar levels of satisfaction (p=0.714) and would recommend ECG screening to other athletes at similar rates (p=0.322). Compared with athletes with a normal screen, athletes with false-positive results also reported feeling safer during competition (p>0.01). In contrast, athletes with false-positive screens were more concerned about the possibility of sports disqualification (p<0.001) and the potential for developing a future cardiac condition (p<0.001).

Conclusions Athletes with a false-positive ECG do not experience more anxiety than athletes with a normal screen but do express increased concern regarding sports disqualification and the development of a cardiac disorder. These findings do not justify avoiding advanced cardiovascular screening protocols. Further understanding of athlete experiences could better prepare the practising physician to counsel athletes with an abnormal ECG.

  • ECG
  • sudden cardiac death
  • prevention
  • sport
  • athlete

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Footnotes

  • Contributors IMA: contributed to the conception, design, data collection, analysis, manuscript preparation and manuscript review. SA: contributed to the design, data collection, analysis, manuscript preparation and manuscript review. JAE: contributed to the design, data collection, analysis, manuscript preparation and manuscript review. RA: contributed to the data collection, analysis and manuscript review. BS: contributed to the data collection, analysis and manuscript review. KC: contributed to the data collection, analysis and manuscript review. JR: contributed to the design, data collection, analysis, manuscript preparation and manuscript review. KGH: contributed to the conception, design, data collection, analysis, manuscript preparation and manuscript review. JAD: contributed to the conception, design, data collection, analysis, manuscript preparation and manuscript review.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval Greenville Health System.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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