The clinical value of routine biannual monitoring in primary care in ADHD medication users

Background

ADHD is increasingly diagnosed and treated in adulthood. While ADHD medication is effective in reducing core symptoms, concerns remain regarding potential adverse outcomes. Biannual monitoring (NICE guidelines) is not always done properly in primary care. Empirical evidence supporting the effectiveness of biannual monitoring is limited. The objectives of this study were to examine 1) whether adults using ADHD medication have an increased risk of cardiovascular diseases and suicide attempts compared to non-users, and 2) whether routine biannual monitoring contributes to early detection of these outcomes.

Methods

A retrospective observational study was conducted using electronic health record data from a Dutch general practice (2006 to 2025). Adults using ADHD medication (n = 1,317) were compared with non-users (n = 42,560). 1) With logistic regression we assessed associations between ADHD medication use and cardiovascular disease and suicide attempts (on the basis of prescribed cardiovascular medication and ICPC codes), with adjustment for age and gender. 2) Time-to-event analyses were used to evaluate the timing of suicide attempts in relation to the initiation of ADHD medication.

Results

1) ADHD medication use was significantly associated with a higher risk of cardiovascular disease OR = 2.09, 95% CI [1.52, 2.88] and suicide attempts OR = 2.80, 95% CI [1.55, 5.07].

2) Suicide attempts occur relatively soon after initiation of ADHD medication, with a median time of 200 days.

Conclusions

Adults using ADHD medication were found to have an increased risk of cardiovascular disease and suicide attempts (the latter particularly shortly after treatment initiation). Recommendation is to continue routine biannual monitoring in primary care, whilst prioritizing the monitoring of suicidal risk shortly after treatment initiation. With some European countries with a doubled or tripled prevalence of ADHD diagnoses (2010-2023), monitoring becomes even more important.

Key messages

• Adults using ADHD medication were found to have an increased risk of cardiovascular disease. The risk for suicide attempts, is particularly higher shortly after treatment initiation.

• Routine biannual monitoring in primary care should prioritize suicidal risk, especially during the early phase of ADHD medication treatment, rather than only cardiovascular measurements.