Practice Differs for Cardiac Screening in ADHD Treatment

Pediatricians vary in attitudes, barriers, practices for screening before initiating stimulants

MONDAY, Jan. 16 (HealthDay News) -- There is considerable variation in the attitudes, barriers, and practices of pediatricians for cardiac screening before initiation of stimulant treatment for attention-deficit/hyperactivity disorder (ADHD), according to a study published online Jan 16 in Pediatrics.

Laurel K. Leslie, M.D., M.P.H., from the Institute for Clinical Research and Health Policy Studies in Boston, and colleagues surveyed 1,600 randomly selected U.S. pediatricians to investigate attitudes, barriers, and practices regarding cardiac screening before initiating stimulant treatment for ADHD; 817 (51 percent) of those surveyed responded, and analyses were based on the 525 respondents (64 percent) who met the eligibility criteria for the study.

The investigators found that, with respect to attitudes, 24 and 30 percent of pediatricians agreed that the risk for sudden cardiac death (SCD) and legal liability, respectively, were high enough to justify cardiac evaluation; while 75 percent agreed that doctors were responsible for alerting families to the risks of SCD. Only 18 percent of pediatricians recognized performing an in-depth cardiac history and physical examination (H & P) as a barrier to identifying cardiac disorders, whereas 71 percent considered interpreting pediatric electrocardiograms (ECGs) to be a barrier. Before initiating stimulant treatment, 93 percent of pediatricians completed a routine H & P, 48 percent completed an in-depth cardiac H & P, and 15 percent requested an ECG; 46 percent reported discussing stimulant-related cardiac risks with families.

"Variable pediatrician attitudes and cardiac screening practices reflect the limited evidence base and conflicting guidelines regarding cardiac screening," the authors write.

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