Stages of psychological impact after diagnosis with serious or potentially lethal cardiac disease in young competitive athletes: A new model

Irfan M. Asif, David Price, Leslee A. Fisher, Rebecca A. Zakrajsek, Leslie K. Larsen, Johannes Raabe, Matthew P. Bejar, Ashwin L. Rao, Kimberly G. Harmon, Jonathan A. Drezner

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

Importance Sudden cardiac death (SCD) in sports is a tragic event. Pre-participation cardiovascular screening is required before participation in high school and college athletic programs and is universally endorsed by major medical societies. The medical impact of a diagnosis may be life-saving; however, the detection of disease should not be the sole endpoint of care. Physicians have an obligation to attend to both the medical and psychological well-being of their patients. Objective To determine the psychological impact of being diagnosed with cardiac disease in young competitive athletes. Design Athletes diagnosed with cardiac conditions were recruited to participate in a semi-structured interview, which was analyzed by sport psychology experts using qualitative research. Individuals shared reactions and experiences regarding diagnosis, lifestyle implications, coping strategies, major concerns, and overall impact on psychosocial functioning. Setting Young competitive athletes from across the United States. Participants 25 athletes (52% male, 80% Caucasian, median age 17.7) participated. Diagnoses included: 5 hypertrophic cardiomyopathy, 8 Wolff Parkinson White, 4 long QT syndrome, 3 atrial septal defect, 2 supraventricular tachycardia, and 3 other. Main outcome measures Interviews were analyzed using consensual qualitative research (CQR) to identify domains, categories, and core ideas. Results Athletes progressed through 4 stages of psychological impact including: 1) immediate reactions and challenge to athlete identity, 2) grief/coping, 3) adaptation, and 4) acceptance. Risk factors for increased psychological morbidity included: higher level of competition, permanent disqualification from sports, persistent reminders (e.g. daily medication, monitoring heart rate during activity), and unanticipated outcomes (e.g. failed procedures). Those undergoing simple corrective procedures came to terms with their diagnosis quickly with little impact on daily life. Few athletes described emotional support mechanisms provided by medical programs. Diagnosis often led to new goals such as mentoring or coaching. All athletes diagnosed through advanced cardiovascular screening stated they would repeat the process. Conclusions and relevance Athletes diagnosed with cardiac disease represent an emotionally vulnerable population and experience 4 stages of psychological adjustment not previously described. This proposed model of psychological impact should be used to develop improved support mechanisms, awareness, and education to assist athletes diagnosed with serious or potentially lethal cardiac disease.

Original languageEnglish (US)
Pages (from-to)298-310
Number of pages13
JournalJournal of Electrocardiology
Volume48
Issue number3
DOIs
StatePublished - May 1 2015

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Athletes
Heart Diseases
Psychology
Sports
Qualitative Research
Interviews
Psychological Models
Supraventricular Tachycardia
Grief
Medical Societies
Hypertrophic Cardiomyopathy
Sudden Cardiac Death
Vulnerable Populations
Life Style
Heart Rate
Outcome Assessment (Health Care)
Morbidity
Physicians
Education

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Asif, Irfan M. ; Price, David ; Fisher, Leslee A. ; Zakrajsek, Rebecca A. ; Larsen, Leslie K. ; Raabe, Johannes ; Bejar, Matthew P. ; Rao, Ashwin L. ; Harmon, Kimberly G. ; Drezner, Jonathan A. / Stages of psychological impact after diagnosis with serious or potentially lethal cardiac disease in young competitive athletes : A new model. In: Journal of Electrocardiology. 2015 ; Vol. 48, No. 3. pp. 298-310.
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abstract = "Importance Sudden cardiac death (SCD) in sports is a tragic event. Pre-participation cardiovascular screening is required before participation in high school and college athletic programs and is universally endorsed by major medical societies. The medical impact of a diagnosis may be life-saving; however, the detection of disease should not be the sole endpoint of care. Physicians have an obligation to attend to both the medical and psychological well-being of their patients. Objective To determine the psychological impact of being diagnosed with cardiac disease in young competitive athletes. Design Athletes diagnosed with cardiac conditions were recruited to participate in a semi-structured interview, which was analyzed by sport psychology experts using qualitative research. Individuals shared reactions and experiences regarding diagnosis, lifestyle implications, coping strategies, major concerns, and overall impact on psychosocial functioning. Setting Young competitive athletes from across the United States. Participants 25 athletes (52{\%} male, 80{\%} Caucasian, median age 17.7) participated. Diagnoses included: 5 hypertrophic cardiomyopathy, 8 Wolff Parkinson White, 4 long QT syndrome, 3 atrial septal defect, 2 supraventricular tachycardia, and 3 other. Main outcome measures Interviews were analyzed using consensual qualitative research (CQR) to identify domains, categories, and core ideas. Results Athletes progressed through 4 stages of psychological impact including: 1) immediate reactions and challenge to athlete identity, 2) grief/coping, 3) adaptation, and 4) acceptance. Risk factors for increased psychological morbidity included: higher level of competition, permanent disqualification from sports, persistent reminders (e.g. daily medication, monitoring heart rate during activity), and unanticipated outcomes (e.g. failed procedures). Those undergoing simple corrective procedures came to terms with their diagnosis quickly with little impact on daily life. Few athletes described emotional support mechanisms provided by medical programs. Diagnosis often led to new goals such as mentoring or coaching. All athletes diagnosed through advanced cardiovascular screening stated they would repeat the process. Conclusions and relevance Athletes diagnosed with cardiac disease represent an emotionally vulnerable population and experience 4 stages of psychological adjustment not previously described. This proposed model of psychological impact should be used to develop improved support mechanisms, awareness, and education to assist athletes diagnosed with serious or potentially lethal cardiac disease.",
author = "Asif, {Irfan M.} and David Price and Fisher, {Leslee A.} and Zakrajsek, {Rebecca A.} and Larsen, {Leslie K.} and Johannes Raabe and Bejar, {Matthew P.} and Rao, {Ashwin L.} and Harmon, {Kimberly G.} and Drezner, {Jonathan A.}",
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Asif, IM, Price, D, Fisher, LA, Zakrajsek, RA, Larsen, LK, Raabe, J, Bejar, MP, Rao, AL, Harmon, KG & Drezner, JA 2015, 'Stages of psychological impact after diagnosis with serious or potentially lethal cardiac disease in young competitive athletes: A new model', Journal of Electrocardiology, vol. 48, no. 3, pp. 298-310. https://doi.org/10.1016/j.jelectrocard.2014.12.018

Stages of psychological impact after diagnosis with serious or potentially lethal cardiac disease in young competitive athletes : A new model. / Asif, Irfan M.; Price, David; Fisher, Leslee A.; Zakrajsek, Rebecca A.; Larsen, Leslie K.; Raabe, Johannes; Bejar, Matthew P.; Rao, Ashwin L.; Harmon, Kimberly G.; Drezner, Jonathan A.

In: Journal of Electrocardiology, Vol. 48, No. 3, 01.05.2015, p. 298-310.

Research output: Contribution to journalArticle

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T2 - A new model

AU - Asif, Irfan M.

AU - Price, David

AU - Fisher, Leslee A.

AU - Zakrajsek, Rebecca A.

AU - Larsen, Leslie K.

AU - Raabe, Johannes

AU - Bejar, Matthew P.

AU - Rao, Ashwin L.

AU - Harmon, Kimberly G.

AU - Drezner, Jonathan A.

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N2 - Importance Sudden cardiac death (SCD) in sports is a tragic event. Pre-participation cardiovascular screening is required before participation in high school and college athletic programs and is universally endorsed by major medical societies. The medical impact of a diagnosis may be life-saving; however, the detection of disease should not be the sole endpoint of care. Physicians have an obligation to attend to both the medical and psychological well-being of their patients. Objective To determine the psychological impact of being diagnosed with cardiac disease in young competitive athletes. Design Athletes diagnosed with cardiac conditions were recruited to participate in a semi-structured interview, which was analyzed by sport psychology experts using qualitative research. Individuals shared reactions and experiences regarding diagnosis, lifestyle implications, coping strategies, major concerns, and overall impact on psychosocial functioning. Setting Young competitive athletes from across the United States. Participants 25 athletes (52% male, 80% Caucasian, median age 17.7) participated. Diagnoses included: 5 hypertrophic cardiomyopathy, 8 Wolff Parkinson White, 4 long QT syndrome, 3 atrial septal defect, 2 supraventricular tachycardia, and 3 other. Main outcome measures Interviews were analyzed using consensual qualitative research (CQR) to identify domains, categories, and core ideas. Results Athletes progressed through 4 stages of psychological impact including: 1) immediate reactions and challenge to athlete identity, 2) grief/coping, 3) adaptation, and 4) acceptance. Risk factors for increased psychological morbidity included: higher level of competition, permanent disqualification from sports, persistent reminders (e.g. daily medication, monitoring heart rate during activity), and unanticipated outcomes (e.g. failed procedures). Those undergoing simple corrective procedures came to terms with their diagnosis quickly with little impact on daily life. Few athletes described emotional support mechanisms provided by medical programs. Diagnosis often led to new goals such as mentoring or coaching. All athletes diagnosed through advanced cardiovascular screening stated they would repeat the process. Conclusions and relevance Athletes diagnosed with cardiac disease represent an emotionally vulnerable population and experience 4 stages of psychological adjustment not previously described. This proposed model of psychological impact should be used to develop improved support mechanisms, awareness, and education to assist athletes diagnosed with serious or potentially lethal cardiac disease.

AB - Importance Sudden cardiac death (SCD) in sports is a tragic event. Pre-participation cardiovascular screening is required before participation in high school and college athletic programs and is universally endorsed by major medical societies. The medical impact of a diagnosis may be life-saving; however, the detection of disease should not be the sole endpoint of care. Physicians have an obligation to attend to both the medical and psychological well-being of their patients. Objective To determine the psychological impact of being diagnosed with cardiac disease in young competitive athletes. Design Athletes diagnosed with cardiac conditions were recruited to participate in a semi-structured interview, which was analyzed by sport psychology experts using qualitative research. Individuals shared reactions and experiences regarding diagnosis, lifestyle implications, coping strategies, major concerns, and overall impact on psychosocial functioning. Setting Young competitive athletes from across the United States. Participants 25 athletes (52% male, 80% Caucasian, median age 17.7) participated. Diagnoses included: 5 hypertrophic cardiomyopathy, 8 Wolff Parkinson White, 4 long QT syndrome, 3 atrial septal defect, 2 supraventricular tachycardia, and 3 other. Main outcome measures Interviews were analyzed using consensual qualitative research (CQR) to identify domains, categories, and core ideas. Results Athletes progressed through 4 stages of psychological impact including: 1) immediate reactions and challenge to athlete identity, 2) grief/coping, 3) adaptation, and 4) acceptance. Risk factors for increased psychological morbidity included: higher level of competition, permanent disqualification from sports, persistent reminders (e.g. daily medication, monitoring heart rate during activity), and unanticipated outcomes (e.g. failed procedures). Those undergoing simple corrective procedures came to terms with their diagnosis quickly with little impact on daily life. Few athletes described emotional support mechanisms provided by medical programs. Diagnosis often led to new goals such as mentoring or coaching. All athletes diagnosed through advanced cardiovascular screening stated they would repeat the process. Conclusions and relevance Athletes diagnosed with cardiac disease represent an emotionally vulnerable population and experience 4 stages of psychological adjustment not previously described. This proposed model of psychological impact should be used to develop improved support mechanisms, awareness, and education to assist athletes diagnosed with serious or potentially lethal cardiac disease.

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