Yesterday
(April 21), the AAP learned for the first time of a new
statement released by the American Heart Association (AHA)
that advocates screening children for cardiac conditions
before and during treatment with stimulant drugs for ADHD.
This new statement may be viewed on the AHA
Web site. Many news outlets are covering the story this
week, and your patients may have questions.
The
AHA statement recommends using heart rate and blood pressure
checks and screening for conditions with related cardiac
symptoms before prescribing stimulant drugs for ADHD. It
also recommends that each child diagnosed with ADHD be given
an electrocardiogram before these drugs are prescribed.
Pediatric
patients are routinely screened for heart health and risk
factors as part of preventive pediatric care, and those
with certain symptoms are referred for further evaluation
as appropriate.
The
approach recommended by the AHA is a cautious one.
The
current
AAP treatment guideline for ADHD does not contain specific
recommendations for cardiac screening or frequency of heart
rate and blood pressure monitoring for these patients. It
does more broadly recommend monitoring these patients for
known side effects of the particular drugs they are taking.
As of February 2007, the FDA has required that medications
used to treat ADHD be accompanied by information warning
about the use of these drugs in patients with heart problems.
The
Academy's diagnosis and treatment guidelines for ADHD are
being revised, and new science as well as case reports related
to both cardiology and drug safety will be reviewed as part
of that process.
It may
not be feasible to refer all patients with an ADHD diagnosis
for an electrocardiogram given the limited number of cardiology
specialists and technicians available to provide these services
nationally. As noted by the AHA, inability to obtain this
test should not preclude providing needed treatment to any
child.
Pediatricians
can reassure their patients' parents and caregivers that
their children's heart health has been evaluated as part
of normal well-child care, including many of the items noted
in the AHA statement. While electrocardiograms are certainly
useful in diagnosing underlying heart conditions, they are
not perfect and occasionally provide confusing results.
Meanwhile, many practitioners may find it helpful to incorporate
increased monitoring of cardiac function into their regular
monitoring of ADHD patients as a precaution until evidence-based
research is available.
