Impact of Electrocardiogram Screening in National Collegiate Athletic
Association Athletes
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
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.
for Discussion:  What do you think about
cardiac screening?  Have you had any
experiences with athletes who have had false positive results?
Nicole Cattano
by: Jeffrey Driban