Emory University School of Medicine, Department of Pediatrics, Children's Healthcare of Atlanta, Atlanta, GA, USA.
Division of Pediatric Cardiology Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA.
Cardiol Young. 2021 Jun;31(6):969-972. doi: 10.1017/S1047951120004965. Epub 2021 Feb 1.
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.
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.
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.
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.
普通人群中注意力缺陷/多动障碍的患病率很常见，现在有 4%-12%的儿童被诊断出患有该疾病。患有先天性心脏病的儿童患注意力缺陷/多动障碍的风险增加。病例报告引起了人们对在患有潜在先天性心脏病的儿童中使用注意力缺陷/多动障碍药物的关注。我们假设患有先天性心脏病和注意力缺陷/多动障碍的患者的药物治疗是安全的。
进行了一项单中心回顾性图表审查，评估了在 5 年内接受过注意力缺陷/多动障碍治疗的年龄在 4-21 岁之间的先天性心脏病患者的不良事件。纳入标准为先天性心脏病诊断和同时使用安非他命、哌甲酯或托莫西汀进行药物治疗。患有轻微或自发缓解的先天性心脏病的患者被排除在分析之外。
在 831 名接受兴奋剂治疗的先天性心脏病患者中，平均年龄为 12.9 岁，仅发现 1 例不良心血管事件。使用敏感性分析，我们的中位随访时间为 686 天，不良事件的患病率为 0.21%。该事件包括一名在开始药物治疗前就有这种情况的患者的室上性心动过速频率增加；该病症在停止注意力缺陷/多动障碍治疗后得到改善。
我们人群中严重不良心血管事件的发生率与普通人群中室上性心动过速的发生率相似。我们的单中心经验表明，患有注意力缺陷/多动障碍和潜在先天性心脏病的儿童的药物治疗与不良事件相关的风险没有增加。需要进一步的基于人群的研究来验证这些发现。
