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Cardiovascular risk screening before starting stimulant medications and prescribing practices of canadian physicians: impact of the Health Canada advisory
- Source :
- Pediatrics. 122(4)
- Publication Year :
- 2008
-
Abstract
- OBJECTIVE. In May 2006, Health Canada released a statement advising against the use of stimulant medications for patients with cardiac disease after isolated reports of sudden death. The objectives of this study were to determine whether the Health Canada advisory has had an impact on cardiovascular screening of all children with attention-deficit/hyperactivity disorder before stimulants and the medical treatment of children with attention-deficit/hyperactivity disorder and real or potential cardiac problems. METHODS. Two questionnaires were developed and mailed to a sample of noncardiologist physicians and pediatric cardiologists in Canada. The difference in the proportion of noncardiologist-responders who performed a “full screen” before and after the announcement of the Health Canada advisory was analyzed. Willingness to prescribe stimulant medications to children was assessed by using a series of clinical scenarios. RESULTS. A total of 2326 questionnaires were distributed, 717 (31%) of which were returned. The proportion who performed a full screen increased for both noncardiologists and cardiologists after the advisory. There was also a dramatic increase in the use of the “modified screen” by the noncardiologist group and the pediatrician subgroup. There was a considerable decrease in the proportion of noncardiologists who were willing to prescribe stimulant medications to children with potential or actual cardiac issues after the advisory. CONCLUSIONS. The Health Canada advisory has had an impact on clinical practice. It has resulted in an increase in the use of cardiovascular assessment tools before starting stimulants and a decrease in noncardiologists' willingness to prescribe stimulants to those with real or potential cardiac disease. These changes have occurred despite the lack of studies to address the cardiac risks of these medications. Because it will be difficult to assess the true cardiac risks of stimulants, consensus recommendations are needed to determine whether screening is required, what constitutes an appropriate screen, and which children can be treated cautiously with stimulant medications.
- Subjects :
- medicine.medical_specialty
Attitude of Health Personnel
medicine.medical_treatment
Advisory Committees
Disease
Sudden death
Drug Prescriptions
Surveys and Questionnaires
Medicine
Attention deficit hyperactivity disorder
Humans
Mass Screening
Practice Patterns, Physicians'
Child
Mass screening
Cardiac problems
Medical treatment
business.industry
Middle Aged
medicine.disease
Stimulant
Risk screening
Nova Scotia
Attention Deficit Disorder with Hyperactivity
Cardiovascular Diseases
Pediatrics, Perinatology and Child Health
Emergency medicine
Central Nervous System Stimulants
business
Delivery of Health Care
Subjects
Details
- ISSN :
- 10984275
- Volume :
- 122
- Issue :
- 4
- Database :
- OpenAIRE
- Journal :
- Pediatrics
- Accession number :
- edsair.doi.dedup.....5c7f8de7a9b4c933e479f96aa9336e18