The Psychological Impact of Cardiovascular Screening in Young Athletes: Perspectives Across Age, Race, and Gender

Objective: To determine the psychological impact of electrocardiogram (ECG) screening in young competitive athletes based on age, race, and gender. Design: Prospective multisite cross-sectional investigation. Setting: Young competitive athletes. Patients: One thousand five hundred six high school athletes (59.3% male with a mean age of 15.5 years, 56.2% white, 24.5% African American). Independent Variables: Athletes underwent screening with a standardized American Heart Association-based history, physical examination, and ECG. Main Outcome Measures: Prescreen and postscreen validated assessments for health attitudes, anxiety, and impact of screening on sport. Results: Of the athletes participated, 76.3% had normal screens, 22.7% false-positive (FP) results (12.9% history, 4.2% examination, 3.1% ECG), and 0.9% were diagnosed with serious cardiac disorders. There were no differences in anxiety levels among athletes screening normal versus FP (P = 0.69). There was no difference in anxiety based on the reason for a FP result (history, physical examination, or ECG) both during (P = 0.95) and after (P = 0.40) screening. Analysis by age, race, and gender demonstrated that before screening, females were more likely to prefer knowing about underlying cardiac conditions compared with males (P < 0.001), and males were less concerned about having cardiac disease (P < 0.001) compared with females. African Americans were less concerned about underlying disease (P < 0.001) and less interested (P < 0.001) in cardiac screening compared with whites. Athletes diagnosed with a cardiac disease described anxiety after screening, but still believe that all athletes should receive an ECG before competition. Conclusions: Electrocardiogram screening does not cause excessive anxiety in US high school athletes across spectrums of age, race, and gender. Recognition of age, race, and gender-specific perspectives could improve physician-patient dialogue and support mechanisms for those diagnosed with potentially lethal cardiac disorders.