Parental anxiety levels before and after pediatric cardiology evaluation with echocardiography in asymptomatic children with heart murmurs: a prospective study

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KIZTANIR H., Elmali B.

FRONTIERS IN PEDIATRICS, cilt.14, 2026 (SCI-Expanded, Scopus)

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Background: Cardiac murmurs are common in childhood, yet their detection often triggers significant parental anxiety. This study aimed to measure anxiety levels in parents of infants and young children under 24 months of age referred to pediatric cardiology due to heart murmurs, using the State-Trait Anxiety Inventory (STAI-S) before and after examination, and to investigate the impact of expert assessment and echocardiography (ECHO). Methods: This prospective study included parents of 241 asymptomatic children (under 24 months) referred for initial cardiac evaluation due to a murmur. Parental anxiety was measured using the STAI-S before and after a comprehensive clinical evaluation, including ECHO. Participants were categorized based on ECHO findings: normal, benign physiological findings, and minor structural anomalies requiring follow-up. Results: The mean pre-consultation STAI-S was 51.17 +/- 6.34, which significantly decreased to 45.89 +/- 7.84 following evaluation [t (240) = 10.44, p < 0.001, Cohen's d = 0.67]. While anxiety levels dropped significantly across all ECHO groups (p < 0.001), no statistical difference was found between groups regarding anxiety reduction (p = 0.108). Exploratory item analysis revealed that consultation primarily reduced negative emotions rather than immediately increasing positive emotional states. Regression analysis showed that a family history of heart disease was the only significant independent predictor increasing pre-examination anxiety (beta = 2.129; p = 0.031). Conclusions: Specialized pediatric cardiology consultation and echocardiographic evaluation substantially reduce parental anxiety, independent of socioeconomic characteristics or specific cardiac findings in this cohort. Clinicians should prioritize early, tailored communication for high-risk families with a family history of heart disease to effectively manage the psychological burden of a heart murmur referral.