Practice Guidelines

AAP Responds to AHA Guideline on Cardiovascular Monitoring Before Starting Stimulants for ADHD



FREE PREVIEW Log in or buy this issue to read the full article. AAFP members and paid subscribers get free access to all articles. Subscribe now.


FREE PREVIEW Subscribe or buy this issue. AAFP members and paid subscribers get free access to all articles.

Am Fam Physician. 2009 May 15;79(10):910.

  See related Practice Guideline.

  Related Editorial

Guideline source: American Academy of Pediatrics

Literature search described? No

Evidence rating system used? Yes

Published source: Pediatrics, August 2008

Available at: http://pediatrics.aappublications.org/content/vol122/issue2/index.shtml

A recent guideline from the American Heart Association (AHA) recommended routine electrocardiography (ECG) in children before they begin pharmacotherapy for attention-deficit/hyperactivity disorder (ADHD). That recommendation contradicts evidence-based recommendations from the American Academy of Child and Adolescent Psychiatry and the American Academy of Pediatrics (AAP). These organizations concluded that sudden cardiac death in persons taking medications for ADHD is rare, with rates no higher than those in the general population of children and adolescents.

There is no evidence that routine ECG screening before beginning medical therapy for ADHD prevents sudden death. Furthermore, limiting children's access to effective ADHD treatment could have serious implications (e.g., substance abuse, academic problems).

No association has been established between sudden cardiac death and medicines used to treat ADHD. Of the 2.5 million children and adolescents who took stimulants for ADHD over five years, 19 died suddenly, resulting in a base rate of fewer than two incidents per year per 1 million children. Reported rates of sudden cardiac death in the general child and adolescent population are substantially higher.

The AAP recommends that physicians carefully assess children being considered for ADHD therapy by using a targeted cardiac history (e.g., patient history of cardiac disease, palpitations, syncope, or seizures; family history of sudden death in children or adolescents; hypertrophic cardiomyopathy; long QT syndrome) and a physical examination, including a cardiac examination.

The AAP encourages physicians to continue to follow current recommendations for ADHD treatment, including the use of stimulants, without obtaining routine ECG before beginning therapy.

Coverage of guidelines from other organizations does not imply endorsement by AFP or the AAFP.


Copyright © 2009 by the American Academy of Family Physicians.
This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Contact afpserv@aafp.org for copyright questions and/or permission requests.

Want to use this article elsewhere? Get Permissions


Article Tools

  • Print page
  • Share this page
  • AFP CME Quiz

Information From Industry

Navigate this Article