Re: Re: ECGs May Help Prevent Stimulant-Related Deaths

[Guest guest]

Thank you very much . Even scarier than I thought after reading it.

--and to hear that doctor tell me how my daughter --who is not yet diagnosed

with ADHD but has " features " they say----such as wiggly and impatient with

getting answers etc but otherwise pays attention in class and does her work for

quite a bit of time before she expires--so it's not like we're at the point of

" What are we going to do they'll kick her out of school if we don't do

soemthing! " --and I've seen parents deal with that too--but DEATH!?!!--So she's

pretty much a typical 5 year old in this sense--but with apraxia of course, and

possible visual and/or auditory language processing issues we're just now

exploring--and to--to hear how easily she recommended a trial

with---I........soemthing---telling me it may help her in the classroom---just

makes me sick. How can they take something that may not even be a problem---

especially given that we know she as a neurological speech disorder and is at

higher risk for learning disorders etc...and throw a

brain numbing drug at her that may kill her???---

Parents should just beware--the least invasive, least harmful approaches need to

reach them before the doctors with the drugs do or they will never be able to

make the right choices --once they start the drugs it amy be too late.

Thanks

Elena

________________________________

From: kiddietalk <kiddietalk@...>

Sent: Fri, March 12, 2010 4:55:36 PM

Subject: [ ] Re: ECGs May Help Prevent Stimulant-Related

Deaths

Elena to answer your question....YES -Wow so scary -thank GOD I never put Dakota

on these medications that I can't even tell you how many neuroMDs tried to get

me to put him on. The drug companies are linking these deaths to only those

that have undiagnosed heart issues. I spoke with a few doctor friends of mine

about this and we wonder if these drugs CAUSE heart issues!!! Check out the

article from a law firm directly below.

I just googled the title and found it -maybe you just googled too early? Yes

not good to post these type of newsletters unless you find a specific article to

share and post a link.

What I just tweeted via @thelatetalker

Deaths from ADHD drugs Due to pre-existing heart issue? http://bit.ly/c7s23x

or linked to creating heart issue? http://bit.ly/bSIquY

Arrhythmia/EP

ECG screening found cost-effective in kids with ADHD considered for stimulant

drugs

March 8, 2010 | Steve Stiles

Bethesda, MD - Given the potential for proarrhythmia in the stimulant drugs

frequently prescribed for attention-deficit/hyperactivity disorder (ADHD), which

are generally contraindicated in children with heart disorders, a report in

Circulation published online March 8, 2010 examines how cost-effective it would

be to screen treatment candidates with electrocardiography [1]. Children who

test positive for heart abnormalities could avoid the stimulants, which are

thought to increase the risk of sudden cardiac death and most prominently

include methylphenidate (Ritalin, Novartis).

The analysis of several hypothetical options for adding 12-lead ECG to the

current screening standard, history and physical, concludes that provisional ECG

(performing the test only if the history and physical are negative), with

cardiologist referral if any evaluation is abnormal, is of " borderline "

cost-effectiveness. An ECG-only screening strategy, interestingly, would be a

more cost-effective approach, according to the authors, led by Dr Denchev

(National Institute of Mental Health, Bethesda, MD). They adhered to the

commonly cited cost-effectiveness definition of <$50 000 per quality-adjusted

life-year (QALY) saved.

Routinely screening with ECG only was more cost-effective than the provisional

addition of ECG, the group says, because the two strategies would generate a

" nearly identical " number of true positives, but the ECG-only strategy would

produce substantially fewer false positives. That is, the provisional-ECG

approach would " deprive more children without heart disease of the benefits of

stimulant treatment for ADHD. "

The major benefit of screening appears to be the opportunity to identify

children with heart disease and restrict them from competitive sports.

American Heart Association recommendations made in 2008 [2] and extensively

" corrected " a few months later, as reported at the time by heartwire, says it is

" reasonable " to obtain ECGs as part of the evaluation but also that it's at the

physician's discretion. A statement from the American Academy of Pediatrics,

issued about the same time, takes a firmer stand against routine ECG screening

[3].

In the current analysis, based on screening of seven-year-old children, the

provisional approach would entail an incremental cost of $39 300 per QALY saved,

compared with $27 000 per QALY saved if referral were prompted only by a

positive ECG. The additional cost per averted case of sudden death was

determined to be $1.6 million and $1.2 million, respectively.

The group, by necessity, makes a number of other assumptions to guide their

analysis. For example, they write, " neither the size nor even the existence " of

an increased risk of sudden death with stimulant therapy has been proven, so

their analysis puts the risk at " a conservative base-case value of 10%. "

Another was that all children who screen positive for heart disease not only

avoid stimulant therapy, they also avoid competitive sports. As it turned out,

that stipulation had a profound effect on the analysis because, the authors

note, both the ECG-only and provisional-ECG strategies remained cost-effective

even when the stimulant-associated rise in sudden-death risk was assumed to be

zero.

Therefore, they write, " The major benefit of screening appears to be the

opportunity to identify children with heart disease and restrict them from

competitive sports. It follows that our principal findings are likely to apply

to heart-disease screening in children overall, independently of ADHD,

particularly in candidates for competitive sports. "

In an accompanying editorial [4], Drs K Triedman and Mark E

(Children's Hospital Boston and Harvard Medical School, MA) laud Denchev et al

for their " rigorous and well-reasoned " analysis and for " diligently " seeking the

best estimates in the literature for their model's parameters.

But they call the sports-participation issue " the elephant in the room " that

" confuses rather than clarifies the issue of ADHD as a standalone indication for

screening. "

" It is clear that this parameter as selected is prone to become the principal

driver of the findings of the model constructed so carefully here, " they write,

so " it is no surprise whatsoever that the effect of sports participation swamps

the resultant analysis. "

« Previous heartwire article

Overweight, obese gain greater benefit from BP lowering

Mar 8, 2010 16:00 EST Next heartwire article »

" Warranty period " for zero calcium score is at least four years

Mar 8, 2010 17:00 EST

Sources

1. Denchev P, Kaltman J, Schoenbaum M, Vitiello B. Modeled economic

evaluation of alternative strategies to reduce sudden cardiac death among

children treated for attention deficit/hyperactivity disorder. Circulation 2010;

DOI:10.1161/CIRCULATIONAHA.109.901256. Available at:

http://circ.ahajournals.org.

2. Vetter VL, Elia J, kson C, et al. 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.

Circulation 2008; 117:2407-2423.

3. Perrin JM, Friedman RA, Knilans TK. Cardiovascular monitoring and

stimulant drugs for attention-deficit/hyperactivity disorder. Pediatrics 2008;

122:451-453.

4. Triedman JK, ME. A needle in a haystack: modeling the incidence

of sudden cardiac arrest in healthy children. Circulation 2010; in press.

Available at: http://circ.ahajournals.org.

http://www.theheart.org/article/1053107.do

ADHD Drug Study Finds Heart Death Risks for Kids, But FDA Says Recommendations

Won't Change

Jun 16, 2009 | Waichman Alonso LLP While a new study has found that

stimulant medications used to treat attention-deficit hyperactivity disorder

(ADHD) may increase the risk of sudden cardiac death in children, the Food &

Drug Administration (FDA) is not changing its recommendations on the way such

drugs are prescribed. According to a posting on its website, the agency is

asserting that the study had " limitations " that makes it difficult to draw

conclusions about the drugs' risks.

Labeling for drugs like Ritalin, Adderall, Dexedrine, and Concerta already

include warnings about the risk of sudden cardiac death in patients with heart

problems, but they have been considered safe for children who don't have

pre-existing heart conditions. There have been worries, however, that such

stimulants could be risky in children with undiagnosed heart problems. It is

not known how often cardiac events occur in children taking these drugs.

According to a report on WebMD, concerns about the drugs' heart risks were

raised in 2006, when an FDA panel reported that between 1992 and 2005, 11 sudden

cardiac deaths occurred in children taking Ritalin and Concerta, and 13 sudden

cardiac deaths occurred among children taking Adderall and Dexedrine. Last

year, the American Heart Association recommended screening all children and

teens taking ADHD drugs for hidden heart problems, as well electrocardiogram

screening of all patients being placed on the stimulants for the first time,

WebMD said.

This latest study on ADHD stimulant drugs, which was published in the American

Journal of Psychiatry, did find a slight increase in the risk of sudden cardiac

death among children and teens taking the medications. The study was funded by

the FDA and the National Institute of Mental Health.

According to the FDA, the study compared the use of stimulant medications in 564

healthy children from across the United States who died suddenly, most likely

due to sudden cardiac disturbance, to the use of stimulant medications in 564

children who died as passengers in a motor vehicle accident. According to the

study report, out of the children who died suddenly, 10 were reported to be

taking a stimulant medication at the time of death. Out of those who died in a

motor vehicle accident, two were reported to be taking a stimulant medication at

the time of death. Researchers concluded that the odds of using stimulant

medication were six to seven times greater among the children who died suddenly

of unexplained causes than among those who died in car crashes.

However, the FDA maintains that the study had several limitations, including the

significant time lag between when the deaths occurred and when the information

was collected. Given such limitations, the FDA said it is unable to conclude

that the data presented in the study affect the overall risk-and-benefit profile

of stimulant medications used to treat ADHD in children. The agency said that

parents should not stop a child’s stimulant medication based on the

study. Instead, parents should discuss concerns about the use of these

medications with the prescribing health care professional, FDA said.

According to report in the Los Angeles Times, for more conclusive answers,

parents of ADHD children are going to have to wait for the results of two more

studies due to be released next fall and winter. Those studies will look at

rates of heart attack and stroke in children and adults who take stimulant

medication for ADHD and compare them to cardiovascular events in populations not

on ADHD medication, the Times said.

http://www.yourlawyer.com/articles/read/16643

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