Low Risk of Cardiac Complications During Long-Term Follow-Up of Opioid Dependence.

IF 4.2 3区医学 Q1 SUBSTANCE ABUSE

Journal of Addiction Medicine Pub Date : 2024-09-01 Epub Date: 2024-06-05 DOI:10.1097/ADM.0000000000001317

Chris Tremonti, David S Celemajer, Christina Marel, Katherine Mills, Shawn Foo, Jack Wilson, Tim Slade, Maree Teesson, Paul Haber

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引用次数: 0

Abstract

Objectives: To prospectively assess rates of QT prolongation, arrhythmia, syncope, and sudden cardiac death (SCD) in a cohort of people with heroin dependence.

Methods: To estimate rates of QT prolongation, arrhythmia, and syncope, a subcohort (n = 130) from the Australian Treatment Outcomes Study, a prospective longitudinal cohort study of 615 people with heroin dependence, underwent medical history, venepuncture, and ECG at the 18- to 20-year follow-up.To estimate rates of SCD, probabilistic matching for the entire cohort was undertaken with the Australian Institute of Health and Welfare National Death Index. Deaths were classified into suicide, accidental overdose, trauma, unknown, and disease, which were then further subclassified by probability of SCD. SCD rate was the number of possible or probable SCDs divided by total patient years from the cohort.

Results: From the subcohort, 4 participants (3%) met the criteria for QT prolongation; 3 were prescribed methadone. Seven participants (5%) reported history of arrhythmia, including 2 transferred from methadone to buprenorphine. Thirty participants (23%) reported a previous syncopal event-14 diagnosed as nonarrhythmic syncope and 13 not investigated. In the previous 12 months, 66 participants (51%) reported heroin use; 55 participants (42%) were prescribed methadone. No participant had QTc greater than 500 milliseconds.There were 3 possible SCDs, translating to an estimated SCD rate of 0.29 (CI: 0.05, 0.8) events per 1000 patient years. More cohort members died of overdose (n = 50), suicide (n = 11), and hepatitis C (n = 4).

Conclusions: Low rates of QT prolongation, arrhythmia, syncope, and SCD in the cohort despite high rates of heroin use and methadone treatment.

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阿片类药物依赖长期随访期间心脏并发症风险较低

目的前瞻性评估海洛因依赖者队列中QT延长、心律失常、晕厥和心脏性猝死（SCD）的发生率：澳大利亚治疗结果研究是一项对 615 名海洛因依赖者进行的前瞻性纵向队列研究，为了估算 QT 间期延长、心律失常和晕厥的发生率，对该研究的一个子队列（n = 130）进行了病史、静脉穿刺和 18-20 年随访时的心电图检查。死亡分为自杀、意外用药过量、外伤、未知和疾病，然后根据 SCD 的概率进一步细分。SCD率是可能或疑似SCD的数量除以队列中患者的总年数：子队列中有 4 名参与者（3%）符合 QT 间期延长的标准；其中 3 人服用了美沙酮。7名参与者（5%）报告有心律失常病史，其中包括2名从美沙酮转用丁丙诺啡的患者。30 名参与者（23%）报告曾发生过晕厥事件，其中 14 人被诊断为非心律失常性晕厥，13 人未接受调查。在过去 12 个月中，66 名参与者（51%）报告使用过海洛因；55 名参与者（42%）被处方美沙酮。没有人的 QTc 超过 500 毫秒。有 3 例可能的 SCD，估计每 1000 患者年的 SCD 发生率为 0.29（CI：0.05，0.8）次。更多队列成员死于用药过量（50 人）、自杀（11 人）和丙型肝炎（4 人）：尽管使用海洛因和接受美沙酮治疗的比例较高，但队列中QT延长、心律失常、晕厥和SCD的发生率较低。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Addiction Medicine 医学-药物滥用

CiteScore

6.10

自引率

9.10%

发文量

260

审稿时长

>12 weeks

期刊介绍： The mission of Journal of Addiction Medicine, the official peer-reviewed journal of the American Society of Addiction Medicine, is to promote excellence in the practice of addiction medicine and in clinical research as well as to support Addiction Medicine as a mainstream medical sub-specialty. Under the guidance of an esteemed Editorial Board, peer-reviewed articles published in the Journal focus on developments in addiction medicine as well as on treatment innovations and ethical, economic, forensic, and social topics including: •addiction and substance use in pregnancy •adolescent addiction and at-risk use •the drug-exposed neonate •pharmacology •all psychoactive substances relevant to addiction, including alcohol, nicotine, caffeine, marijuana, opioids, stimulants and other prescription and illicit substances •diagnosis •neuroimaging techniques •treatment of special populations •treatment, early intervention and prevention of alcohol and drug use disorders •methodological issues in addiction research •pain and addiction, prescription drug use disorder •co-occurring addiction, medical and psychiatric disorders •pathological gambling disorder, sexual and other behavioral addictions •pathophysiology of addiction •behavioral and pharmacological treatments •issues in graduate medical education •recovery •health services delivery •ethical, legal and liability issues in addiction medicine practice •drug testing •self- and mutual-help.