Heart test urged before kids get ADHD drugs

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Heart

test urged before kids get ADHD drugs

Stimulants

can leave some vulnerable to cardiac arrest, heart group says

updated 2 hours, 6 minutes ago

NEW YORK - Children

should be screened for heart problems with an electrocardiogram before getting

drugs like Ritalin to treat hyperactivity and attention-deficit disorder, the

American Heart Association recommended Monday.

Stimulant drugs can

increase blood pressure and heart rate. For most children, that isn't a

problem. But in those with heart conditions, it could make them more vulnerable

to sudden cardiac arrest — an erratic heartbeat that causes the heart to

stop pumping blood through the body — and other heart problems.

About 2.5 million

American children and 1.5 million adults take medication for attention-deficit

hyperactivity disorder, or ADHD, according to government estimates. Stimulant

drugs, like Ritalin, Adderall and Concerta, help children with ADHD to stay

focused and control their behavior.

The medications already carry warnings

of possible heart risks in those with heart defects or other heart problems,

which some critics said were driven more by concerns of overuse of the drugs

than their safety.

The heart group is

now recommending a thorough exam, including a family history and an EKG, before

children are put on the drugs to make sure that they don't have any undiagnosed

heart issues.

" We don't want

to keep children who have this from being treated. We want to do it as safely

as possible. " said Dr. Vetter, a pediatric cardiologist at the

University of Pennsylvania School of Medicine and head of the committee making

the recommendation.

The label warnings

were added after a review by the Food and Drug Administration of its databases

found reports of 19 sudden deaths in children treated with ADHD drugs and 26

reports of other problems including strokes and fast heart rates between 1999

and 2003. There were also reports of heart problems in adults; the committee

didn't look at adults.

An EKG can detect

abnormal heart rhythms that can lead to sudden cardiac arrest. Children who are

already on ADHD drugs should also be tested, Vetter said. If problems are

found, the child should be sent to a pediatric cardiologist. With careful

monitoring, Vetter said. children with heart problems can take the medicines if

needed.

The cost of an EKG

varies depending on who does it and the location. For example, the amount that

Aetna Inc. pays ranges from $24 to $50. Vetter said Children's Hospital of Philadelphia, where she works, has been

doing EKG screening for three years and it has been covered by insurance.

She said a

screening of about 1,100 children found that about 2 percent of them had some

kind of heart problem.

" We thought it

was reasonable to include the electrocardiogram as a tool for the pediatrician,

the psychiatrist so that this would help identify additional children who have

heart disease, " Vetter said.

Psychiatrist

'baffled' by recommendation

But Dr. Pliszka, a child psychiatrist at the University of Texas

in San ,

said he was baffled by the EKG recommendation. He said there's no evidence that

sudden death is a bigger problem for children taking stimulants than for

children who aren't taking the drugs.

Pliszka said an EKG

might deter people from seeking treatment because it's an added expense and

hassle. Psychiatrists aren't likely to have an EKG machine, and pediatricians

might not either, making patients go elsewhere to get the test, he said.

An ADHD advocacy

group called CHADD said parents should monitor their child's reaction to all

medications. EKG screening " will bring an even further measure of safety

to what is already a safe clinical treatment approach, " the group said.

The American Academy of Child and Adolescent

Psychiatry recently updated its treatment guidelines for ADHD, and did not

recommend routine EKGs, said Pliszka, who was the lead author. He has received

research support or served as a consultant for makers of ADHD drugs.

" We definitely

did not feel we needed to screen everyone, " Pliszka said.

He noted that the

heart association doesn't recommended EKG screening for young athletes to

prevent sudden death. The group has said it wasn't feasible or cost-effective

to screen all student athletes.

A spokeswoman for

Novartis Pharmaceuticals Corp., which makes Ritalin, said the company had not

seen the latest heart association statement and could not comment, but she

pointed out that the label does suggest patients be evaluated for heart

problems.

Micki

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