Most pediatricians skip ECG before starting ADHD stimulants

Results of a survey of American Academy of Pediatrics (AAP) members show that most US pediatricians bypass an electrocardiogram (ECG) before starting children on stimulant medication for attention-deficit/hyperactivity disorder (ADHD), opting for a routine cardiac history and physical examination instead.

Case reports have raised concerns about the risk of cardiac events associated with use of stimulants for the treatment of ADHD. The American Heart Association recommends obtaining a baseline ECG along with a cardiac history and physical examination to detect problems that could lead to sudden cardiac death (SCD) before starting stimulants. In contrast, AAP says that a routine ECG is not warranted for most children before starting these drugs.

A representative sample of 817 AAP-member pediatricians completed a self-administered survey regarding attitudes and practices about cardiac screening of children with ADHD. Seventy-five percent of the respondents agreed that physicians are responsible for informing families about SCD risk before initiating stimulants, and 46% reported discussing stimulant-related cardiac risks with their own patients. Nearly 93% said they completed a routine history and physical before prescribing stimulants. Only 48%, however, conducted an in-depth cardiac history and physical, and just 15% ordered an ECG.

Interpreting a pediatric ECG was the most commonly cited barrier to identifying cardiac disorders, mentioned by 71% of respondents, whereas only 18% said that performing an in-depth cardiac history and physical was a barrier.

The researchers say that varying physician attitudes and cardiac screening practices reflect the lack of evidence and conflicting guidelines on cardiovascular risks associated with stimulant medications and that data are urgently needed. Two-thirds of respondents indicated an interest in continuing medical education on the topic.

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