Pre-existing cardiovascular conditions and pharmacological treatment of adult ADHD
Tobias Gerhard1, Almut G Winterstein, Mark Olfson
1Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, NJ 08901, USA. tgerhard@rci.rutgers.edu
Insights
Adults with ADHD and cardiovascular conditions are less likely to be prescribed stimulant medications. Atomoxetine initiation is not affected by these conditions, though many patients still receive stimulants.
Area of Science:
- Pharmacology
- Cardiology
- Psychiatry
Background:
- Stimulants and atomoxetine require caution in adults with pre-existing cardiovascular conditions.
- The impact of cardiovascular conditions on ADHD medication initiation in adults is not well understood.
Purpose of the Study:
- To investigate how pre-existing cardiovascular conditions influence the initiation of stimulant or atomoxetine treatment in adults with Attention-Deficit/Hyperactivity Disorder (ADHD).
Main Methods:
- A retrospective cohort study analyzed privately insured adults with new ADHD treatment episodes.
- Pre-existing cardiovascular conditions were identified using ICD-9-CM codes.
- Multivariate logistic regression assessed the likelihood of initiating stimulant or atomoxetine therapy.
Main Results:
- 10.5% of patients had pre-existing cardiovascular conditions.
- Patients with cardiovascular conditions were less likely to initiate stimulant therapy (AOR 0.71).
- This effect was more pronounced in younger adults; atomoxetine initiation was unaffected.
Conclusions:
- Pre-existing cardiovascular conditions decrease the likelihood of initiating stimulant therapy for adult ADHD.
- Atomoxetine initiation remains unaffected by cardiovascular conditions.
- A significant number of adult ADHD patients with cardiovascular conditions still initiate stimulant therapy.
Background:
Stimulants and atomoxetine should generally not be used or used only with caution in adults with pre-existing cardiovascular conditions. The extent to which pre-existing cardiovascular conditions influence initiation of these ADHD medications in adults is not known.
Methods:
We performed a retrospective cohort study of privately insured adults with new ADHD treatment episodes. Pre-existing cardiovascular conditions were assessed by the presence of ICD-9-CM codes for congenital abnormalities, atherosclerosis, cardiac disease, and cerebrovascular disease in the 12 months before the index ADHD diagnosis. The primary outcome was new initiation of a stimulant or atomoxetine in the 3 months after the index date. Multivariate logistic regression was used to predict the likelihood of treatment initiation with stimulants or atomoxetine based on pre-existing cardiovascular conditions, patient demographic characteristics, clinical mental disorder comorbidities, other psychotropic drug use, and provider type.
Results:
Of 8752 patients with a new ADHD treatment episode, 917 (10.5%) had evidence of >or=1 pre-existing cardiovascular condition. Stimulants were started by 40.8% of patients with and 53.0% of patients without pre-existing cardiovascular conditions (Adjusted Odds Ratio, AOR 0.71; 95%CI 0.61-0.82). Pre-existing cardiovascular conditions reduced the likelihood of initiating stimulant treatment in younger but not in older patients (p-value for age x cardiovascular condition interaction = 0.0002). Initiation of atomoxetine treatment was not affected by pre-existing cardiovascular conditions (AOR 1.19, 95%CI 0.94-1.50).
Conclusions:
Pre-existing cardiovascular conditions reduce the likelihood of stimulant therapy but not atomoxetine treatment in adult ADHD patients. However, many adult ADHD patients with pre-existing cardiovascular conditions initiate stimulant therapy.
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