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The impact of diagnosis: measuring the psychological response to being diagnosed with serious or potentially lethal cardiac disease in young competitive athletes
  1. Irfan M Asif1,
  2. David E Price2,
  3. Alex Ewing1,
  4. Ashwin L Rao3,
  5. Kimberly G Harmon3,
  6. Jonathan A Drezner3
  1. 1Greenville Health System/University of South Carolina Greenville School of Medicine, Greenville, South Carolina, USA
  2. 2Carolinas Medical Center, Charlotte, North Carolina, USA
  3. 3University of Washington, Seattle, Washington, USA
  1. Correspondence to Dr Irfan M Asif, Greenville Health System/University of South Carolina Greenville School of Medicine, Greenville, SC 29650, USA; IAsif{at}sc.edu

Abstract

Aim To determine the psychological impact of athletes diagnosed with cardiac disease.

Methods and design Athletes diagnosed with cardiovascular disorders were recruited to complete the Impact of Event Scale (IES), a validated tool measuring responses to a traumatic event. IES scoring =0–88 (<12= normal, 12–32=recommend monitoring, >33=significant stress reaction). Subscales include: intrusion, avoidance and hyperarousal.

Results 30 athletes (53% male, 83% Caucasian, median age 18.0, median age at diagnosis 15.7) participated. Diagnoses included: 6 hypertrophic cardiomyopathy, 9 Wolff Parkinson White, 4 Long QT syndrome, 3 atrial septal defect, 2 supraventricular tachycardia and 6 other. For the group, the mean IES-Revised (IES-R) score=16.6 (SD=12.1), subscales: intrusion 6.6 (SD=4.3), avoidance=7.4 (SD=6.5), hyperarousal=2.7 (SD=3.5). Higher risk individuals included: permanently disqualified athletes (p<0.01), athletes requiring daily medication (p<0.01), those with genetically inheritable conditions (p<0.01), and athletes undergoing medical management instead of definitive therapy (p<0.01). No differences were reported by gender (male=16.6, female=16.6). Higher IES-R scores were reported in more competitive athletes (college=17.8, high school=13.3; p=0.369) and African-American individuals (African-American=25.8, Caucasian=14.8 p=0.061), although not statistically significant. Athletes with cardiomyopathy (IES-R=24) and channelopathy (IES-R=28) reported the highest IES results. Athletes with high IES-R scores were most likely to psychologically respond through avoidance of feelings/situations/ideas.

Conclusions Athletes diagnosed with potentially lethal cardiac disorders are at risk for significant psychological distress. These athletes tend to avoid thoughts, feelings and conversations associated with their diagnosis and should be offered consistent emotional support to mitigate psychological morbidity.

Significance Currently, there are no recommendations to guide physicians on how to support an athlete that is newly diagnosed with a potentially career altering heart condition. Proper planning and use of appropriate support mechanisms can be useful for emotionally vulnerable athletes.

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