American Heart Association Recommends Cardiac Screening for Children Taking Stimulants
The American Heart Association released a statement this week that children with ADHD should be screened for possible heart problems before starting treatment with stimulant medications and that those who already are taking stimulants, should also be checked. Specifically, according to the statement, children should receive an electrocardiogram (ECG) to rule out heart abnormalities.
Since stimulants can increase blood pressure and heart rate, a child with an underlying cardiac problem could be at risk for various heart problems. Though this sounds like an alarming recommendation for the parents of the many children receiving stimulant medication, it's important to note that only about 2 percent of children who were screened, had some kind of heart problem.
There is controversy as to whether the recommendation might be an overreaction. Dr. Steven Pliszka, a child psychiatrist at the University of Texas in San Antonio said he was baffled by the EKG recommendation, stating there is no evidence of more sudden deaths in children taking stimulants vs children in the general population. In addition, he is concerned that children needing ADHD treatment might not receive it, due to the expense of the medical test and the hassle in finding a medical professional who can administer it. Most psychiatrists and pediatricians do not have EKG machines in their offices.
CHADD (Children and Adults with ADHD) said parents should monitor their child's reaction to all medications. EKG screening "will bring an even further measure of safety to what is already a safe clinical treatment approach."
CHADD's statement included a reminder that there are over fifty years of published research documents showing that "stimulant medications do not pose a serious cardiac risk for children and adolescents who do not have an underlying cardiac problem." The organization recommends a complete medical examination for all children who are evaluated for ADHD and that parents who have concerns about stimulant medications should discuss them with the child's medical treatment team.
The medications already carry warnings of possible heart risks in those with heart defects or other heart problems, with some critics pointing out that these were driven more by concerns of potential overuse of stimulants rather than their safety.
Interestingly, The American Academy of Child and Adolescent Psychiatry recently updated its treatment guidelines for ADHD, and did not recommend routine EKGs, pointed out Pliszka, who was the lead author.
Says Dr. Victoria Vetter, head of the American Heart Association's writing committee and professor of pediatrics at the University of Pennsylvania School of Medicine in Philadelphia: "Children who have abnormalities on the test can still be treated for attention deficit as long as they are monitored by a pediatric cardiologist. Young patients should also have access to the drugs even if they can't get the test for some reason, such as cost or access."
Other ADHD experts chimed in with a variety of opinions.
Dr. David Fassler, professor of psychiatry at the University of Vermont's College of Medicine noted, "No evidence exists suggesting such widespread screening would improve safety or reduce the risk of rare though serious heart risks. Parents should talk about the risks with their child's doctor and determine what tests are needed."
Dr. Thomas Brown, associate director of the attention and related disorders clinic at Yale Medical School in New Haven, Connecticut, said "The request was reasonable. Parents must remember the risks are rare and most children have no problem with treatment. The idea that's important here is not that these drugs are so dangerous, but rather that there are a few people out there, because of a family history or genetics, that are a little more vulnerable.''
The AHA recommendations don't apply to adults who are taking stimulants for ADHD, but Dr. Vetter suggests they consider having their hearts checked, regardless.
Bottom line? Discuss your concerns with your child's physician and ask if a cardiac workup should be considered.
View the American Heart Association's statement HERE