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Treatment of attention deficit/hyperactivity disorder in children with CHD

Published online by Cambridge University Press:  01 February 2021

Alyson R. Pierick Open the ORCID record for Alyson R. Pierick [Opens in a new window] ,
Melodie Lynn ,
Courtney M. McCracken ,
Matthew E. Oster  and
Glen J. Iannucci
Alyson R. Pierick*
Affiliation:
Emory University School of Medicine, Department of Pediatrics, Children’s Healthcare of Atlanta, Atlanta, GA, USA
Melodie Lynn
Affiliation:
Division of Pediatric Cardiology Texas Children’s Hospital, Baylor College of Medicine, Houston, TX, USA
Courtney M. McCracken
Affiliation:
Emory University School of Medicine, Department of Pediatrics, Children’s Healthcare of Atlanta, Atlanta, GA, USA
Matthew E. Oster
Affiliation:
Emory University School of Medicine, Department of Pediatrics, Children’s Healthcare of Atlanta, Atlanta, GA, USA
Glen J. Iannucci
Affiliation:
Emory University School of Medicine, Department of Pediatrics, Children’s Healthcare of Atlanta, Atlanta, GA, USA
*
Author for correspondence: Dr A. R. Pierick, MD, Emory University School of Medicine, Department of Pediatrics, 49 Jesse Hill Jr Dr SE, Atlanta, GA 30303, USA. Tel: +1 (319)541-8325; Fax: 770-488-9477. E-mail: [email protected]
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Abstract

Introduction:

The prevalence of attention deficit/hyperactivity disorder in the general population is common and is now diagnosed in 4%–12% of children. Children with CHD have been shown to be at increased risk for attention deficit/hyperactivity disorder. Case reports have led to concern regarding the use of attention deficit/hyperactivity disorder medications in children with underlying CHD. We hypothesised that medical therapy for patients with CHD and attention deficit/hyperactivity disorder is safe.

Methods:

A single-centre, retrospective chart review was performed evaluating for adverse events in patients aged 4–21 years with CHD who received attention deficit/hyperactivity disorder therapy over a 5-year span. Inclusion criteria were a diagnosis of CHD and concomitant medical therapy with amphetamines, methylphenidate, or atomoxetine. Patients with trivial or spontaneously resolved CHD were excluded from analysis.

Results:

In 831 patients with CHD who received stimulants with a mean age of 12.9 years, there was only one adverse cardiovascular event identified. Using sensitivity analysis, our median follow-up time was 686 days and a prevalence rate of 0.21% of adverse events. This episode consisted of increased frequency of supraventricular tachycardia in a patient who had this condition prior to initiation of medical therapy; the condition improved with discontinuation of attention deficit/hyperactivity disorder therapy.

Conclusion:

The incidence of significant adverse cardiovascular events in our population was similar to the prevalence of supraventricular tachycardia in the general population. Our single-centre experience demonstrated no increased risk in adverse events related to medical therapy for children with attention deficit/hyperactivity disorder and underlying CHD. Further population-based studies are indicated to validate these findings.

Keywords

Attention deficit/hyperactivity disorderCHDstimulantsarrhythmias
Type
Original Article
Information
Cardiology in the Young , Volume 31 , Issue 6 , June 2021 , pp. 969 - 972
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Copyright
© The Author(s), 2021. Published by Cambridge University Press

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References

Batra, AS, Alexander, ME, Silka, MJ. Attention-deficit/hyperactivity disorder, stimulant therapy, and the patient with congenital heart disease: evidence and reason. Pediatr Cardiol 2012; 33: 394–401.CrossRefGoogle ScholarPubMed
Razzaghi, H, Oster, M, Reefhuis, J. Long-term outcomes in children with congenital heart disease: national Health Interview Survey. J Pediatr 2015; 166: 119–124.CrossRefGoogle ScholarPubMed
Yamada, DC, Porter, AA, Conway, JL, et al. Early repair of congenital heart disease associated with increased rate of attention deficit hyperactivity disorder symptoms. Can J Cardiol 2013; 29: 1623–1628.CrossRefGoogle ScholarPubMed
Shillingford, AJ, Glanzman, MM, Ittenbach, RF, Clancy, RR, Gaynor, JW, Wernovsky, G. Inattention, hyperactivity, and school performance in a population of school-age children with complex congenital heart disease. Pediatrics 2008; 121: e759–e767.CrossRefGoogle Scholar
Mahle, WT, Clancy, RR, Moss, EM, Gerdes, M, Jobes, DR, Wernovsky, G. Neurodevelopmental outcome and lifestyle assessment in school-aged and adolescent children with hypoplastic left heart syndrome. Pediatrics 2000; 105: 1082–1089.CrossRefGoogle ScholarPubMed
DeMaso, DR, Calderon, J, Taylor, GA, et al. Psychiatric disorders in adolescents with single ventricle congenital heart disease. Pediatrics 2017; 139: e20162241.CrossRefGoogle ScholarPubMed
Kirshbom, PM, Flynn, TB, Clancy, RR, et al. Late neurodevelopmental outcome after repair of total anomalous pulmonary venous connection. J Thorac Cardiovasc Surg 2005; 129: 1091–1097.CrossRefGoogle ScholarPubMed
Holland, JE, Cassidy, AR, Stopp, C, et al. Psychiatric disorders and function in adolescents with tetralogy of Fallot. J Pediatr 2017; 187: 165–173.CrossRefGoogle ScholarPubMed
Hovels-Gurich, HH, Konrad, K, Skorzenski, D, Herpertz-Dahlmann, B, Messmer, BJ, Seghaye, MC. Attentional dysfunction in children after corrective cardiac surgery in infancy. Ann Thorac Surg 2007; 83: 1425–1430.CrossRefGoogle ScholarPubMed
Cooper, WO, Habel, LA, Sox, CM, et al. ADHD drugs and serious cardiovascular events in children and young adults. N Engl J Med 2011; 365: 1896–1904.CrossRefGoogle ScholarPubMed
Vetter, VL, Elia, J, Erickson, 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.CrossRefGoogle Scholar
Winterstein, AG, Gerhard, T, Kubilis, P, et al. Cardiovascular safety of central nervous system stimulants in children and adolescents: population based cohort study. BMJ 2012; 345: e4627.CrossRefGoogle ScholarPubMed
Berger, S. Attention deficit hyperactivity disorder medications in children with heart disease. Curr Opin Pediatr 2016; 28: 607–612.CrossRefGoogle ScholarPubMed
Findling, RL, Short, EJ, Manos, MJ. Short-term cardiovascular effects of methylphenidate and adderall. J Am Acad Child Adolesc Psychiatry 2001; 40: 525–529.CrossRefGoogle ScholarPubMed
Torres-Acosta, N, O’Keefe, JH, O’Keefe, CL, Lavie, CJ. Cardiovascular effects of ADHD therapies: JACC review topic of the week. J Am Coll Cardiol 2020; 76: 858–866.CrossRefGoogle Scholar
FDA Drug Safety Communication. Safety Review Update of Medications used to treat Attention-Deficit/Hyperactivity Disorder (ADHD) in adults, 2011. https://www.fda.gov/drugs/drug-safety-and-availability/fda-drug-safety-communication-safety-review-update-medications-used-treat-attention-0#SAhttp://www.fda.Google Scholar
Orejarena, LA, Vidaillet, H, Jr., DeStefano, F, et al. Paroxysmal supraventricular tachycardia in the general population. J Am Coll Cardiol 1998; 31: 150–157.CrossRefGoogle ScholarPubMed
Barkley, RA. International consensus statement on ADHD. J Am Acad Child Adolesc Psychiatry 2002; 41: 1389.CrossRefGoogle ScholarPubMed
Marino, BS, Lipkin, PH, Newburger, JW, et al. Neurodevelopmental outcomes in children with congenital heart disease: evaluation and management: a scientific statement from the American Heart Association. Circulation 2012; 126: 1143–1172.CrossRefGoogle ScholarPubMed
Posner, J, Polanczyk, GV, Sonuga-Barke, E. Attention-deficit hyperactivity disorder. Lancet 2020; 395: 450–462.CrossRefGoogle ScholarPubMed
Tripathi, A, Black, GB, Park, YM, Jerrell, JM. Factors associated with the occurrence and treatment of supraventricular tachycardia in a pediatric congenital heart disease cohort. Pediatr Cardiol 2014; 35: 368–373.CrossRefGoogle Scholar