Cardiovascular Monitoring for ADHD
The American Heart Association (AHA) recently published a statement entitled “Cardiovascular Monitoring of Children and Adolescents with Heart Disease Receiving Stimulant Drugs”, which implied that patients receiving such medications should have an electrocardiogram (ECG) performed as a part of routine screening. This has generated discussion throughout the pediatric, cardiology and electrophysiology community, and, in fact, because of confusion and discrepancies an erratum to the article was subsequently published.
After these corrections were made, the American Academy of Pediatrics (AAP) and the American Academy of Child & Adolescent Psychiatry (AACAP) endorsed the statement (it is important to note that the original paper did not include in its authorship any members representing either organization). The Heart Rhythm Society (HRS) and the Pediatric and Congenital Electrophysiology Society (PACES) have yet to endorse the AHA statement.
The Children’s Heart Center cardiologists have reviewed this statement in detail with local representatives from community pediatric groups and child psychiatry, and have discussed this with those who have prepared responses on behalf of the AAP and PACES.
Recently, a working group from the AAP Section on Cardiology and Cardiac Surgery released a summary response to the AHA statement that includes an algorithm for workup of patients who are receiving stimulant medications. In summary:
- Patients with known cardiac disease should receive further evaluation including an ECG.
- Patients with no known cardiac disease should have a history and physical to identify risk factors for congenital heart disease or sudden cardiac arrest.
- If risk factors are identified, further cardiac evaluation is indicated.
- If no risk factors are identified, no further testing is necessary.
We are in agreement with the AAP that it is unnecessary to perform a routine ECG prior to starting stimulant medications unless the patient history, family history or physical examination raise concerns. The most recent statement is located on the AAP Web site. To date, there has been no scientific evidence to suggest that the use of stimulant medications is associated with an increase in the rates of sudden death in any patient population, a fact which is acknowledged by the authors of the original AHA statement.