Response to Adesman and Blaufox re: “Stimulants and Pediatric Cardiovascular Risk”

The Authors' Reply:

We appreciate Drs. Adesman and Blaufox's concerns about overutilizing resources in the face of ever-burgeoning medical costs (Zito and Burcu 2017). We are happy to concede the more conservative approach of routine baseline electrocardiogram when stimulants are initiated if we can all agree to endorse Dr. McClellans's position:

“More intensive screening, such as electrocardiogram monitoring, should be considered for patients with known cardiovascular risks, or for patients on multiple agents, including combinations of stimulants, antidepressants and antipsychotics.”

We base our conclusion partly on our awareness of the growing complexity of medication regimens, particularly among Medicaid-insured youth (Fontanella et al. 2014) and duration of use, even in young children (Burcu et al. 2014).

We continue to advocate for the integration of pediatric and psychiatric care, and are optimistic that electronic medical records will be a giant step forward in the postmarketing surveillance of long-term stimulant use, particularly in complex regimens.

Sincerely,

Julie M. Zito and Mehmet Burcu