Sports Medicine Research: In the Lab & In the Field: Psychological Outcomes After a False Positive ECG (Sports Med Res)


Wednesday, September 20, 2017

Psychological Outcomes After a False Positive ECG

Psychological Impact of Electrocardiogram Screening in National Collegiate Athletic Association Athletes

Asif IM, Annett S, Ewing JA, Abdelfattah R, Sutphin B, Conely K, Rothmier J, Harmon KG, & Drezner JA. Br J Sport Med. 2017; Online Ahead of Print July 24, 2017.  DOI: 10.11336/bjsports-2017-097909

Take Home Message: Athletes who had false positive ECG results had similar anxiety than those who tested normally.  However, they were more concerned about sport disqualification, but felt that more athletes should be screened and felt safer participating.

Electrocardiograms (ECG) can find heart arrhythmias, which may make an athlete susceptible to sudden cardiac death – the leading cause of death among athletes.  However, current recommendations do not support mandatory screening with ECG for all athletes because a thorough medical history should help identify those at risk and the possible negative outcomes of ECG screening; such as, more false positives resulting in athletic disqualification, financial burdens, and emotional distress.  These authors studied the psychological outcomes associated with false-positive ECG screening among collegiate athletes.  In brief, 1192 athletes across 18 sports from 7 NCAA institutions completed psychological surveys before and after a full cardiac prescreening protocol (health history questionnaire, physical examination, and ECG).  If any component of the prescreening protocol was abnormal, further testing was performed.  Almost 97% of the athletes had normal prescreening, about 3% had false-positive results, and 0.3% had a cardiac disorder.  Anxiety levels were similar between athletes with normal and false-positive results.  Athletes who had false-positive results were more concerned about sport disqualification, more likely to feel that all athletes should be screened, felt safer during participation, and were more concerned about developing a future cardiac condition.  When all athletes were asked if they would want to know about any underlying cardiac conditions ~70% indicated that they would want to know rather than playing without knowledge. 

These authors found that false positive findings are not related to greater anxiety than athletes with normal findings when screened for cardiac abnormalities.  However, some athletes who had false positive results were scared about having a disorder or that they might develop one in the future.  With patient-centered care, it is important for clinicians to be aware and sensitive to how an athlete may react following a screening and possibly abnormal result.  As sports medicine clinicians, we often have an outstanding rapport with our patients and are well-equipped to deal with this or to refer if necessary to the appropriate mental health professional.  Within this study, it would be interesting to see how many individuals were screened as abnormal through the ECG – but NOT through the history or physical examination.  The authors admit that since all athletes had an ECG, that they could not compare these athletes to athletes who did not undergo an ECG – but it would be interesting to see if there would be any anxiety differences between those with or without an ECG screening.  It also would have been interesting to investigate the differences between the 70% of the athletes that would rather know if they have a cardiac abnormality compared with the 30% who would rather not know.  In the current study, ~60% of athletes were in Division III. It would be interesting to know if these results would be different among athletes who are hoping to compete professionally in their sport. Ultimately, there are some possible negative reactions to false positive exam findings, but while they are minor clinicians should be aware of these outcomes if someone is being screened. Furthermore, while there may be other reasons to hold off on ECG screening, this study would indicate that emotional distress after a false-positive finding should not be a major concern.

Questions for Discussion:  What do you think about cardiac screening?  Have you had any experiences with athletes who have had false positive results?

Written by: Nicole Cattano
Reviewed by: Jeffrey Driban

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Unknown said...

The article link goes to an article on TENS. I would be interested in the actual article.

Jeffrey Driban said...

Thank you. The link has been updated.

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