Article Text

Download PDFPDF
Does cardiovascular preparticipation screening cause psychological distress in athletes? A systematic review
  1. Braeden Hill1,
  2. Nicholas Grubic1,
  3. Matthew Williamson1,
  4. Dermot M Phelan2,
  5. Aaron L Baggish3,
  6. Paul Dorian4,
  7. Jonathan A Drezner5,
  8. Amer M Johri1
  1. 1Department of Medicine, Queen's University, Kingston, Ontario, Canada
  2. 2Sports Cardiology Center, Atrium Health Sanger Heart and Vascular Institute, Charlotte, North Carolina, USA
  3. 3Cardiovascular Performance Program, Massachusetts General Hospital, Boston, Massachusetts, USA
  4. 4Department of Medicine, Division of Cardiology, University of Toronto, Toronto, Ontario, Canada
  5. 5Center for Sports Cardiology, University of Washington, Seattle, Washington, USA
  1. Correspondence to Dr Amer M Johri, Department of Medicine, Queen's University, Kingston, ON K7L 3N6, Canada; amerschedule{at}


Objective To evaluate the psychological implications of cardiovascular preparticipation screening (PPS) in athletes.

Design Systematic review.

Data sources MEDLINE, EMBASE, PubMed, CINAHL, SPORTDiscus, APA PsycInfo, Cochrane Library and grey literature sources.

Study eligibility criteria Observational and experimental studies assessing a population of athletes who participated in a cardiovascular PPS protocol, where psychological outcomes before, during and/or after PPS were reported.

Methods Results of included studies were synthesised by consolidating similar study-reported measures for key psychological outcomes before, during and/or after screening. Summary measures (medians, ranges) were computed across studies for each psychological outcome.

Results A total of eight studies were included in this review (median sample size: 479). Study cohorts consisted of high school, collegiate, professional and recreational athletes (medians: 59% male, 20.5 years). Most athletes reported positive reactions to screening and would recommend it to others (range 88%–100%, five studies). Increased psychological distress was mainly reported among athletes detected with pathological cardiac conditions and true-positive screening results. In comparison, athletes with false-positive screening results still reported an increased feeling of safety while participating in sport and were satisfied with PPS. A universal conclusion across all studies was that most athletes did not experience psychological distress before, during or after PPS, regardless of the screening modality used or accuracy of results.

Conclusion Psychological distress associated with PPS in athletes is rare and limited to athletes with true-positive findings. To mitigate downstream consequences in athletes who experience psychological distress, appropriate interventions and resources should be accessible prior to the screening procedure.

PROSPERO registration number CRD42021272887.

  • Athletes
  • Cardiology
  • Cardiovascular Diseases
  • Psychology, Sports
  • Sports medicine

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Twitter @braedenhill_, @nickgrubic, @DermotphelanMD, @DreznerJon

  • Presented at American College of Cardiology Scientific Session 2022 (ACC.22)

  • Contributors All authors contributed to the conception and design of this systematic review. Data collection was performed by BH and MW. Data analysis and interpretation were performed by BH, NG, MW and AMJ. The first draft of the manuscript was written by BH, NG and MW. Key edits and critical revisions of the manuscript were provided by AMJ, DMP, ALB, PD and JAD. All authors approved the final version of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests All authors report no competing financial interests. JAD is Editor-in-Chief of the British Journal of Sports Medicine, although was fully recused from the editorial and review process.

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

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.