Update as of Monday, June 2, 2008 for the Cardiac Screening of Pediatric ADHD Patients
The following is an update on the recently released American Academy of Pediatrics (AAP) policy statement regarding cardiac evaluation and monitoring in children and adolescents requiring medical therapy for ADHD. Sibley Heart Center Cardiology physicians support this most recent advisory from the AAP.
Based upon significant concerns raised by the medical community following the initial American Heart Association (AHA) publication, there will be an updated version published in the near future. Last week, however, the AAP released a policy statement stating that obtaining a baseline ECG in children with ADHD is a class IIb recommendation, with level of evidence D.This is in contrast to the recent AHA update, which placed acquiring an ECG as a Class IIa recommendation (level of evidence C). Class II recommendations are those for which there is conflicting evidence and/or a divergence of opinion about the usefulness/efficacy of a procedure or treatment. In Class IIa the weight of evidence/opinion is in favor of usefulness/efficacy; reasonable to perform the procedure or treatment, though additional studies with focused objectives are needed. Level of evidence C is only supported by consensus opinion, case studies or standard of care. In class IIb the usefulness/efficacy is less well-established by evidence/opinion; level of evidence D is based upon expert opinion without even observational studies, and generally does not warrant guideline statements.It should also be noted that a survey a few weeks ago of the international membership of the Pediatric and Congenital Electrophysiology Society (PACES) supported a classification of IIb (usefulness/efficacy is less well-established by evidence/opinion; procedure or treatment may be considered; Class I - 3%, Class IIa - 13%, Class IIb - 69%, Class III - 15%).
Sibley Heart Center Cardiology continues to feel strongly that any cardiac referral should be based upon the results of a thorough patient history and physical examination performed by a primary care provider—our recommended pediatric sudden cardiac risk assessment form for your practice use can be used for patient and family history screening purposes, at any time and any age.
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Please feel free to contact us if you have any questions and/or concerns regarding AAP or AHA statements. We can be reached at 404-256-2593 (800-542-2233) or firstname.lastname@example.org.