title: Cardiovascular risk screening before starting stimulant medications and prescribing practices of canadian physicians: impact of the Health Canada advisory.
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.
authors.affiliation: Division of Pediatric Cardiology and Perinatal Epidemiology Research Unit, Department of Pediatrics, IWK Children's Heart Centre, Halifax, Nova Scotia, Canada. jennifer.conway@iwk.nshealth.ca
authors.forename: Jennifer
authors.initials: J
authors.lastname: Conway
authors.forename: Kenny K
authors.initials: KK
authors.lastname: Wong
authors.forename: Colleen
authors.initials: C
authors.lastname: O'Connell
authors.forename: Andrew E
authors.initials: AE
authors.lastname: Warren
mesh_terms: D026683:Advisory Committees / Q000706:statistics & numerical data*; D001289:Attention Deficit Disorder with Hyperactivity / Q000150:complications / Q000188:drug therapy*; D001291:Attitude of Health Personnel; D002318:Cardiovascular Diseases / Q000150:complications / Q000175:diagnosis*; D000697:Central Nervous System Stimulants / Q000627:therapeutic use*; D002648:Child; D003695:Delivery of Health Care; D011307:Drug Prescriptions / Q000592:standards*; D006801:Humans; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D009674:Nova Scotia; D010818:Practice Patterns, Physicians'; D011795:Surveys and Questionnaires
chemical_list: D000697:Central Nervous System Stimulants