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The psychological impact of cardiovascular screening: the athlete's perspective
  1. Irfan M Asif1,
  2. Serena Johnson2,
  3. Jason Schmieg1,
  4. Tiffany Smith1,
  5. Ashwin L Rao2,
  6. Kimberly G Harmon2,
  7. Jack C Salerno3,
  8. Jonathan A Drezner2
  1. 1Department of Family Medicine, University of Tennessee, Knoxville, Tennessee, USA
  2. 2Department of Family Medicine, University of Washington, Seattle, Washington, USA
  3. 3Division of Cardiology, Department of Pediatrics, University of Washington, Seattle, Washington, USA
  1. Correspondence to Irfan M Asif, Department of Family Medicine, University of Tennessee 1927 Alcoa Hwy U-67, Knoxville, TN 37920, USA; iasif{at}


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 and study design 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.

  • Cardiology prevention
  • Cardiology

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