Appraisal of treatment guidelines for the management of cardiovascular problems in ADHD : A systematic review

Abstract: Background and aim: Recent evidence reveal that there is an increased risk of cardiovascular disease in individuals with attention-deficit/hyperactivity disorder (ADHD), yet no studies have investigated guidelines in the context of cardiovascular health. Our aim is to fill this knowledge gap, to investigate what recommendation clinical practice guidelines (CPGs) provide regarding ADHD medications and cardiovascular risk factors in the context of cardiovascular diseases. Methods: A systematic review was conducted for identifying ADHD CPGs using PubMed, HTA-database and CPG-databases. Inclusion and exclusion criteria were selected and search terms defined. The search was conducted on 3 May 2022 and the records examined by eligibility. The quality of each included guideline was assessed by using part of the Appraisal of Guidelines for Research & Evaluation II (AGREE II) instrument. Results: The eight included CPGs were critically examined. Overall, the recommendations regarding initiating and monitoring ADHD medications were similar in these CPGs while the risk factors were less highlighted. A modified version of AGREE II instrument revealed that five out of eight guidelines contained cardiology expertise in the development group. Conclusion: We were able to identify the lack of recommendations for cardiovascular risk factors (e.g. exercise, obesity, dietary advice and smoking habits) in the context of cardiovascular health. Recommendations regarding initiating and monitoring ADHD medications in relation to cardiovascular diseases were overall similar. Findings from this paper highlight the need to increase the attention given to early prevention and identification of risk factors in individuals with ADHD and to consider strategies to combat these.