Affiliation:
1. Institute for Clinical Research and Health Policy Studies and
2. Floating Hospital for Children, Tufts Medical Center, Boston, Massachusetts; and
3. Tufts University School of Medicine, Boston, Massachusetts
Abstract
OBJECTIVES:
To determine pediatricians’ attitudes, barriers, and practices regarding cardiac screening before initiating treatment with stimulants for attention-deficit/hyperactivity disorder.
METHODS:
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).
RESULTS:
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.
CONCLUSIONS:
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.
Publisher
American Academy of Pediatrics (AAP)
Subject
Pediatrics, Perinatology and Child Health
Reference22 articles.
1. Shire USI. Medication Guide: Adderall XR. Shire US, Inc; 2010. Available at: www.fda.gov/downloads/Drugs/DrugSafety/ucm085819.pdf. Accessed July 28, 2011
2. Cardiovascular monitoring of children and adolescents with heart disease receiving medications for attention deficit/hyperactivity disorder [corrected]: a scientific statement from the American Heart Association Council on Cardiovascular Disease in the Young Congenital Cardiac Defects Committee and the Council on Cardiovascular Nursing;Vetter;Circulation,2008
3. American Academy of Pediatrics/American Heart Association. Clarification of statement on cardiovascular evaluation and monitoring of children and adolescents with heart disease receiving medications for ADHD. 2008; May 16. Available at: http://newsroom.heart.org/pr/aha/american-academy-of-pediatrics-218228.aspx. Accessed July 28, 2011
4. Cardiovascular monitoring and stimulant drugs for attention-deficit/hyperactivity disorder;Perrin;Pediatrics,2008
5. Screening for sudden cardiac death in the young: report from a National Heart, Lung, and Blood Institute working group;Kaltman;Circulation,2011
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