From the Guidelines
For a 16-year-old with first-degree heart block who has ADHD and is non-compliant with prescribed cardiac medications, I strongly recommend implementing a comprehensive approach focusing on medication adherence, including the use of FDA-approved medications for ADHD, such as methylphenidate or amphetamine salts, at appropriate doses, as suggested by the most recent evidence 1. This approach should involve a multidisciplinary team, including both the cardiologist and the psychiatrist, to reassess the current treatment plan and address any concerns or side effects that may be contributing to non-compliance. Key considerations include:
- Using medication reminder apps or pill organizers to help the teen remember to take their cardiac medications
- Ensuring proper ADHD treatment to improve overall medication compliance
- Directly supervising medication administration until the teen demonstrates consistent responsibility
- Regular cardiac monitoring, especially when taking ADHD stimulants which can affect heart rate
- Educating the teen about the importance of their cardiac medications in age-appropriate terms and involving them in treatment decisions to improve compliance
- Discussing any medication side effects with the cardiologist to explore alternative options or dosing schedules, as recommended by recent studies 1. By prioritizing medication adherence and proper ADHD treatment, we can improve the teen's overall quality of life, reduce the risk of morbidity and mortality associated with non-compliance, and ensure the best possible outcome, as emphasized by the most recent and highest quality study 1.
From the Research
Medication Non-Compliance in a 16-Year-Old with 1st Degree Heart Block
- The patient has been prescribed medication by a cardiologist, but is non-compliant with the treatment plan.
- 1st degree heart block is a condition where the electrical impulses that control the heartbeat are delayed as they travel from the atria to the ventricles.
- Beta-blockers, such as metoprolol, are commonly used to treat heart conditions, including atrial fibrillation and heart failure 2, 3.
- However, beta-blockers can also cause atrioventricular (AV) block as a side effect, which can be reversible by discontinuing the medication 4.
- In patients with heart failure, beta-1 selective blockers like metoprolol may be better tolerated than non-selective beta-blockers like carvedilol, especially in older adults 5.
Potential Next Steps
- The cardiologist may need to reassess the patient's treatment plan and consider alternative medications or dosages to improve compliance.
- Education and counseling may be necessary to help the patient understand the importance of adhering to the prescribed treatment plan.
- Regular follow-up appointments with the cardiologist can help monitor the patient's condition and make adjustments to the treatment plan as needed.
- The patient's ADHD may also need to be taken into account when developing a treatment plan, as it can affect medication adherence and overall health outcomes.