Athlete anxiety no excuse to skip heart test: study

After finding that student-athletes felt no more distress about heart screening with electrocardiograms, or ECGs, than they did with physical exams, a new study concludes that anxiety should not be considered a reason to avoid giving the test.

An ECG measures the electrical activity of the heart and can detect disturbances that could predispose people to rare but dangerous cardiac arrests. Sudden cardiac death is the most common cause of death during exercise, researchers note.

Italy and Israel mandate ECG screening as part of sports pre-participation examinations, while the debate over whether to require athletes to get the test has become increasingly contentious in the United States.

One of the downsides of ECGs is that they sometimes suggest a heart problem that turns out to be a false alarm upon further testing. In the interim, athletes may fear for their health or their future in sports.

“This is the first study to look at the psychological impact to athletes when they get screened,” lead author Dr. Irfan Asif told Reuters Health. “There’s nothing to indicate you shouldn’t get an ECG because of stress.”

Asif, from the University of Tennessee Graduate School of Medicine in Knoxville, and his team studied 952 high school athletes who participated in a range of sports. The students all received a medical history and physical examination to screen for underlying heart problems. All but 150, who served as a comparison group, also received an ECG.

Of the 802 participants who were screened with ECG, 220 had an abnormal finding at some point during the screening process. Six of those represented serious heart conditions, and the rest were false positives.

Reviews of a student’s medical history led to 127 of the false positives. An additional 50 false positives were a result of physical exams, 14 were from ECG readings and 29 were due to multiple indications.

The researchers found no difference in students’ distress levels immediately after screening based on whether their testing had included an ECG.

A 2007 American Heart Association statement on cardiovascular screening warns that false-positive results from ECGs could lead to unnecessary anxiety, the authors write in the British Journal of Sports Medicine.

But the current investigation showed no differences in distress levels based on the reason for the false-positive evaluation - the vast majority of which resulted from a review of a student’s personal and family medical history.

“The athletes we’ve interviewed are actually very grateful that someone’s tried to save their lives,” Asif said. “We’re not really seeing negative consequences. We’re seeing very positive benefits.”

But pediatric cardiologist Dr. Peter Fischbach from Children’s Healthcare of Atlanta told Reuters Health the study protocol limited its generalizability. Fischbach, who is also affiliated with Emory University School of Medicine, was not involved with the new study.