Cardiac Screening Prior to Stimulant Treatment of ADHD: A Survey of US-Based Pediatricians

Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA.
PEDIATRICS (Impact Factor: 5.47). 02/2012; 129(2):222-30. DOI: 10.1542/peds.2011-1574
Source: PubMed


To determine pediatricians' attitudes, barriers, and practices regarding cardiac screening before initiating treatment with stimulants for attention-deficit/hyperactivity disorder.
A survey of 1600 randomly selected, practicing US pediatricians with American Academy of Pediatrics membership was conducted. Multivariate models were created for 3 screening practices: (1) performing an in-depth cardiac history and physical (H & P) examination, (2) discussing potential stimulant-related cardiac risks, and (3) ordering an electrocardiogram (ECG).
Of 817 respondents (51%), 525 (64%) met eligibility criteria. Regarding attitudes, pediatricians agreed that both the risk for sudden cardiac death (SCD) (24%) and legal liability (30%) were sufficiently high to warrant cardiac assessment; 75% agreed that physicians were responsible for informing families about SCD risk. When identifying cardiac disorders, few (18%) recognized performing an in-depth cardiac H & P as a barrier; in contrast, 71% recognized interpreting a pediatric ECG as a barrier. When asked about cardiac screening practices before initiating stimulant treatment for a recent patient, 93% completed a routine H & P, 48% completed an in-depth cardiac H & P, and 15% ordered an ECG. Almost half (46%) reported discussing stimulant-related cardiac risks. Multivariate modeling indicated that ≥1 of these screening practices were associated with physicians' attitudes about SCD risk, legal liability, their responsibility to inform about risk, their ability to perform an in-depth cardiac H & P, and family concerns about risk.
Variable pediatrician attitudes and cardiac screening practices reflect the limited evidence base and conflicting guidelines regarding cardiac screening. Barriers to identifying cardiac disorders influence practice.

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Available from: Susan K Parsons, May 09, 2014
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    • "This concurs with another recent recommendation from North America (Hammerness et al., 2011). We note that according to a recent survey in the US, only 15% of paediatricians declared to ask systematically for an ECG before initiating psychostimulant treatment (Leslie et al., 2012). The EAGG points out that for ADHD patients without a known heart disease, the ADHD specialist is the appropriate individual to evaluate risk-benefit and make recommendations for pharmacological treatment. "
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