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HUGE NEWS! New Guidelines Urge Heart Tests Before Kids Take ADHD Drugs!
http://online.wsj.com/article/SB1208...googlenews_wsj
Note from Ilena Rosenthal, Health Lover ... finally, a start in the right direction. http://ilena-rosenthal.blogspot.com New Guidelines Urge Heart Tests Before Kids Take ADHD Drugs By RON WINSLOW April 22, 2008 Children diagnosed with attention deficit and hyperactivity disorder should have a thorough heart work-up, including an electrocardiogram, before taking stimulants such as Ritalin to treat the condition, according to a new recommendation by the American Heart Association. The advice marks the first time a medical-guidelines body in the U.S. has urged wide use of an electrocardiogram, which charts electrical activity in the heart, to screen a presumed healthy population for abnormalities. But there is debate among experts about the value of using the test to screen such a large pool of patients to detect a rare condition. The hope is that such a test -- in combination with a comprehensive checkup -- will help to avoid the rare cases of sudden cardiac arrest that have been linked to the widely used medicines. AN ADHD CARDIAC CHECKLIST A child diagnosed with ADHD should get a thorough heart checkup, including: • Patient and family history, with special attention to palpitations, fainting or recent difficulties during exercise. • A physical, including blood pressure and a check for abnormal heartbeats. • An electrocardiogram to measure electrical function of the heart. • If necessary, a consultation with a pediatric cardiologist to discuss important findings. Source: American Heart Association "The goal is to improve the care of children, including allowing them to have their ADHD treated and have it done safely," says Victoria Vetter, director of electrophysiology at Children's Hospital of Philadelphia and lead author of the heart association's statement. Since 1999, fewer than 30 sudden deaths among children have been linked to the drugs, which are currently taken by more than 2.5 million youngsters in the U.S. Issues of cost, available expertise in reading children's ECGs and concern about false-positive tests are prompting some experts to question the rationale for urging an ECG in particular. "This is a $250 million recommendation," says Mike Ackerman, a pediatric cardiologist at the Mayo Clinic in Rochester, Minn., who estimates the total cost of an ECG at about $100. "We're really trying to find a needle in a haystack, and we have no data yet to know that the screening program they're recommending would capture" those few at-risk individuals. Dr. Ackerman was a member of another American Heart Association panel that last year stopped short of recommending routine ECG screening for heart abnormalities in young competitive athletes. ADHD is a disorder affecting about 4% to 8% of American children ages 4 to 17 (some estimates range as high as 16%), and is marked by inattention and disorganized or impulsive behavior. Critics believe it is overdiagnosed, but left untreated, those who suffer the malady are at heightened risk of such problems as failure in school, car accidents and substance abuse. Drugs prescribed for ADHD include Novartis AG's Ritalin, Shire PLC's Adderall and Eli Lilly & Co.'s Strattera, and they have proved effective in controlling symptoms. The heart association's recommendation applies to all such drugs. Generally, stimulants used to treat ADHD long have been linked to slight increases in blood pressure and heart rate. More seriously, children with underlying congenital heart disease appear to be susceptible to rare episodes of heartbeat irregularities that can cause sudden cardiac arrest. There isn't any evidence linking the drugs to sudden death among children without an underlying congenital heart condition, researchers say. Three years ago, Canadian regulators suspended sales of Adderall based on reports of 20 deaths linked to the medicine over the previous decade. A year later, an advisory panel to the U.S. Food and Drug Administration recommended stringent "black box" warnings on the medicines' labels regarding serious cardiovascular risks. These developments prompted the heart association to review the evidence surrounding the medicines, which led to the statement published Tuesday in the group's chief journal, Circulation. In an exam following an ADHD diagnosis, the statement says, doctors should take a detailed patient and family history looking for, among other things, any episodes of fainting or dizziness, heart palpitations or murmurs or unexplained change in ability to exercise. Patients and family members should disclose any unexplained death or heart attack among young relatives. During a physical, patients should be checked for abnormal heartbeats, high blood pressure or any traits suggestive of Marfan syndrome, a condition associated with structural defects in the heart. An electrocardiogram can detect such abnormalities as a thickening of the heart and a person's risk of runaway heartbeats that can cause sudden death. Dr. Vetter says the ECG is a "recommendation," not a requirement that should prevent children from getting timely access to needed medicines. "If they're on the medication, they shouldn't stop it," she says, but they should get the heart work-up. Patients should have periodic heart checkups while they are taking the medicines. Dr. Vetter believes the cost of ECGs is reasonable and that they would enable doctors to identify and treat patients with heart conditions, which then could enable the patients to more safely take medicines for ADHD. "We don't want to impede treatment of these children," she says. "We are trying to allow them to be safely treated." She also says her own research suggests that about 2% of children have serious heart defects they don't know about, and that an ECG would be able to detect many of them. Still, there is little evidence from clinical studies that suggests the benefit of ECG screening significantly outweighs the costs and other risks. "The field is wrestling with how to screen for sudden death involving young people in a variety of settings and we're really perplexed," says Dr. Ackerman. Reading a child's ECG is especially tricky, he says, and a big risk of a broad screening program is false-positive tests that send children and their families on "an emotional roller coaster" of unneeded and anxiety-provoking tests. And getting a misdiagnosis of a heart defect expunged from a medical record is very difficult, he says. While the sudden death of child is tragic, "if we're going to change a lot of people's lives and spend a lot of money," says Timothy Knilans, director of cardiac electrophysiology at Cincinnati Children's Hospital, "we ought to have a good scientific basis rather than do it on the basis of what might feel right in somebody's gut." Dr. Vetter and her colleagues who published the American Heart Association statement acknowledge that hard data are lacking. They also call for establishing a registry of cases of sudden cardiac death in children, adolescents and young adults, with one goal of learning more about what role ADHD drugs may play in such incidents and what strategies may be effective in preventing them. |
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