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Heart risk in ADHD drugs

Rating

4 Star

Heart risk in ADHD drugs

Our Review Summary

This story reported on the recently published recommendations from the American Heart Association about the value of cardiac screening prior to the prescription of medication for the treatment of ADHD. 

The story is interesting in several ways.  While there is an appropriate emphasis on the recommendation of the AHA on screening that reinforces the FDA view, the tension between the AHA and the American Academy of Pediatric and Adolescent Psychiatry is important and perhaps could have been given a bit more attention.  But the reader is reasonably well informed by the article on the recent recommendation and the apparent disagreement in the need for this level of screening in the medical community.  

The story could have emphasized that although the FDA has required these medications to carry warnings about cardiovascular risks since 2006, it has taken the American Heart Association until 2008 to issue guidelines about this.  It would also be interesting to know whether the discrepancy between the AHA guidelines and those of the AAPAP are a difference in how they interpret the data or a difference in the timeline for making recommendations.

While not done ideally, the risks and benefits of treatment with the stimulants is addressed.  Other therapies, including behavioral approaches could have been noted as alternatives.

Overall, though, this was a good job of reporting.  

Criteria

Does the story adequately discuss the costs of the intervention?

Satisfactory

The story mentioned that at one institution, the EKG test was modest in cost and was paid by insurers.  We wish the story had specified what "relatively modest cost" actually means.  What’s relatively modest to one may be exorbitant to another.  Nonethless, we’ll give the story the benefit of the doubt on this criterion. 

Does the story adequately quantify the benefits of the treatment/test/product/procedure?

Not Satisfactory

Did the story quantify the potential benefit of the recommended screening?  It did spell out how many deaths, strokes, cardiac arrests or other cardiovascular events were reported to the FDA over a six year period.  But there was no estimate given of how many such events would be caught by screening nor how many might be missed – even if the recommendations were followed. 

Does the story adequately explain/quantify the harms of the intervention?

Satisfactory

The story did mention that requiring EKG screening could deter some patients from seeking or obtaining help with management of ADHD.  It might have provided some thoughts about the potential issues that might be arise when screening tests are conducted in individuals without symptoms.

Does the story seem to grasp the quality of the evidence?

Satisfactory

The story did include an estimate for the number of children with ADHD who are treated with medication (2.5 million) and the number of deaths (19) and other serious cardiac related adverse events (26).  That said – it would have been helpful to provide some framework for understanding these numbers – for every 50,000 children treated, 1 child would die or have a heart attack or stroke.

The story mentioned that it was reporting on new guidelines from the American Heart Association that have just been published and that these guidelines differ from the current recommendations of other professional groups. 

Does the story commit disease-mongering?

Satisfactory

The story gave a balanced view of the arguments for and against the screening recommendation.  It also provides information about the number of children taking stimulants for ADHD (2.5 million) and the number of events noted (45 over a six year period).

Does the story use independent sources and identify conflicts of interest?

Satisfactory

The story includes quotes from doctors with differing opinions and perspectives on the screening recommendation.  This was a strength of the story.

Does the story compare the new approach with existing alternatives?

Not Satisfactory

The story provided no indication about whether there were other treatment options available for management of ADHD in general or whether there were options that might be more appropriate for youngsters determined to be at elevated cardiovascular risk. There are other non-stimulant drugs available to treat ADHD as well as behavioral therapies.  In a story like this, these could have been mentioned.

Does the story establish the availability of the treatment/test/product/procedure?

Satisfactory

The story stated right at the beginning that medications prescribed to treat ADHD are taken by millions of children and included a list of several of the more common drugs in the class.  

Does the story establish the true novelty of the approach?

Satisfactory

The story reported on a new recommendation from the American Heart Association.  It noted that the FDA already requires that a warning about these risks be included with the information about these medications.

Does the story appear to rely solely or largely on a news release?

Satisfactory

So many different sources were used that it is clear the story didn’t rely on a news release.

Total Score: 8 of 10 Satisfactory

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