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Routine ECG Not Recommended Prior to Initiating ADHD Treatment, According to Canadian Experts: Presented at CCC

EDMONTON, Alberta -- October 27, 2009 -- Electrocardiograms (ECG) are not recommended as a routine step prior to starting medications employed to control attention deficit/hyperactivity disorder (ADHD), according to a joint statement issued by the Canadian Cardiovascular Society (CCS), the Canadian Pediatric Society (CPS), and the Canadian Academy of Child and Adolescent Psychiatry (CACAP). In this position statement issued at the 2009 Canadian Cardiovascular Congress (CCC), some form of cardiovascular screening is considered appropriate for the stimulants that are commonly used in ADHD treatment, but this can be limited to taking an adequate patient history.

"Routine ECG assessment of ADHD patients prior to starting medication is not supported by evidence and is not recommended," said Andrew Warren, MD, Division of Pediatric Cardiology, Children's Heart Centre, Halifax, Nova Scotia, Canada. Chairman of the writing group for the joint statement, Dr. Warren reported October 26 that observational data suggest that the rate of sudden death, which is the most feared potential cardiovascular complication from these medications, is similar between children taking stimulants and children in the general paediatric population.

This does not mean that ADHD drugs are without risk, particularly in children with pre-existing heart disease. According to Dr. Warren, clinicians should conduct a careful history and physical examination with attention not only to the child's specific medical history but to any familial signals of increased risk for arrhythmias. In patients with suspected heart disease or who have been identified as having risk factors for sudden death, assessment by a cardiologist prior to starting ADHD medication is recommended.

However, in those without clear risk factors, assessment by a primary care physician is appropriate and sufficient. Although the guidelines suggest that the type of history and physical examination employed to identify medical issues in routine patient management is probably sufficient for risk assessment, a screening tool has been provided in the Position Statement issued by the CCS, CPS, and CACAP. The joint statement indicates that the decision to initiate ADHD medication, like all other medications, should be made after considering all potential benefits and risks.

CCC is co-hosted by the Canadian Cardiovascular Society and the Heart and Stroke Foundation of Canada.

[Presentation title: Cardiac Risk Assessment Prior to the Use of Stimulant Medications in Children and Youth: A Joint Position Statement by the Canadian Pediatric Society, the Canadian Cardiovascular Society, and the Canadian Academy of Child and Adolescent Psychiatry. Plenary Presentation, Monday, October 26, 2009]

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