The Use of QT Prolongation Risk Factor Assessment Tool to Assess the Risk of QT Prolongation in Patients Taking Methadone: An Irish Experience

Maitiu O. Tuathail

doi:doi:10.11648/j.ejcbs.20210705.11

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The Use of QT Prolongation Risk Factor Assessment Tool to Assess the Risk of QT Prolongation in Patients Taking Methadone: An Irish Experience

Maitiu O. Tuathail

Published in European Journal of Clinical and Biomedical Sciences (Volume 7, Issue 5)

Received: 4 May 2021 Accepted: 17 May 2021 Published: 16 September 2021

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Abstract

Currently, no tool exists to assist doctors in estimating their patients’ risk of QT prolongation. Methadone is one of many medications which is known to prolong a patient’s QT, and which can lead to Torsades de Pointes and sudden cardiac death. The aim of the study was to design a QT prolongation risk factor assessment tool, for patients taking methadone, which would allow physicians to objectively assess a patient’s risk of QT prolongation. Following a literature review a QT prolongation risk factor assessment tool was created. An audit was then carried out to see what risk factors for QT prolongation were identified prior to use of the tool, in our practice, and then after the tool had been introduced. The introduction of a dedicated QT risk factor assessment tool led to an 61% (39/100 to 100/100) increase in the documentation of individual QT prolongation risk factors in our patients. There was a 100% (4/4) increase in the documentation of risk of QT prolongation in the patient notes, of discussion that risk with patients (4/4), and of the frequency of repeat ECGS (4/4). The introduction of such a QT prolongation risk factor assessment tool in our practice led to an increased awareness of QT prolonging medications, an improvement in the documentation of QT prolonging risk factors and a change in the culture of the practice around medication prescribing and QT prolongation. In patients who are on methadone, a QT prolongation risk factor assessment tool allows for an objective assessment of each patient’s risk of QT prolongation which then allows for measures to be put in place to monitor and address this risk.

Published in	European Journal of Clinical and Biomedical Sciences (Volume 7, Issue 5)
DOI	10.11648/j.ejcbs.20210705.11
Page(s)	75-80
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

Methadone, Addiction, QTC Prolongation

References

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[3]	Delargy I, Crowley D, Van Hout MC. Twenty years of the methadone treatment protocol in Ireland: reflections on the role of general practice. Harm Reduct J. 2019; 16 (1).
[4]	England P health,. Drug Misuse and Dependence. Drug Misuse Depend Uk Guid Clin Manag. 2017; 68–9.
[5]	Krantz MJ, Rowan SB, Schmittner J, Bucher Bartelson B. Physician awareness of the cardiac effects of methadone: results of a national survey. J Addict Dis. 2007; 26 (4): 79–85.
[6]	Health Service Executive. Clinical Guidelines for Opioid Substitution Treatment. Heal Serv Exec [Internet]. 2017; Available from: http://hse.ie/eng/services/publications/Primary/clinical-guidelines-for-opioid-substitution-treatment.pdf
[7]	Taylor DM. Antipsychotics and QT prolongation. Acta Psychiatr Scand. 2003; 107 (2): 85–95.
[8]	Noel ZR, See VY, Flannery AH. Walk the Line—The Importance of Well-Informed Interpretation of QT Prolongation. Ann Pharmacother. 2021; 55 (1): 123–6.
[9]	Schwartz PJ, Woosley RL, Woosley RL. Predicting the Unpredictable: Drug-Induced QT Prolongation and Torsades de Pointes. J Am Coll Cardiol. 2016; 67 (13): 1639–50.
[10]	Sussex Partnership NHS. Guidance on the Use of Antipsychotics version 3.2. 2015; (October 2015): 1–61. Available from: https://www.sussexpartnership.nhs.uk/sites/default/files/documents/antipsychotic_guidelines_version_3.2_-_oct_15_-_with_new_hdat_form_added_-_dec_16_0.pdf
[11]	Cooper SJ, Reynolds GP, Barnes TRE, England E, Haddad PM, Heald A, et al. BAP guidelines on the management of weight gain, metabolic disturbances and cardiovascular risk associated with psychosis and antipsychotic drug treatment. J Psychopharmacol. 2016; 30 (8): 717–48.
[12]	Ali Z, Ismail M, Nazar Z, Khan F, Khan Q, Noor S. Prevalence of QTc interval prolongation and its associated risk factors among psychiatric patients: a prospective observational study. BMC Psychiatry [Internet]. 2020; 20 (1): 277. Available from: https://doi.org/10.1186/s12888-020-02687-w
[13]	Ogungbe O, Akil L, Ahmad HA. Exploring unconventional risk-factors for cardiovascular diseases: Has opioid therapy been overlooked? Int J Environ Res Public Health. 2019; 16 (14).
[14]	Krantz MJ, Martin J, Stimmel B, Mehta D, Haigney MCP. QTc interval screening in methadone treatment. Ann Intern Med. 2009; 150 (6): 387–95.
[15]	Jennifer M Treece, Mohammad Al Madani, George El Khoury, Ola Khraisha, James E Martin, Steven J Baumrucker, Christopher A Neglia TKP. Comprehensive Review on Methadone-Induced QT Prolongation and Torsades. J Pharmacol Pharmacother. 2016; 2 (2): 3–7.
[16]	St James' Hospital, National Medicines Information Centre. 2011; 17 (4): 11–2.
[17]	St James' Hospital, National Medicines Information Centre. 2008; 14 (5).

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APA Style

Maitiu O. Tuathail. (2021). The Use of QT Prolongation Risk Factor Assessment Tool to Assess the Risk of QT Prolongation in Patients Taking Methadone: An Irish Experience. European Journal of Clinical and Biomedical Sciences, 7(5), 75-80. https://doi.org/10.11648/j.ejcbs.20210705.11

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ACS Style

Maitiu O. Tuathail. The Use of QT Prolongation Risk Factor Assessment Tool to Assess the Risk of QT Prolongation in Patients Taking Methadone: An Irish Experience. Eur. J. Clin. Biomed. Sci. 2021, 7(5), 75-80. doi: 10.11648/j.ejcbs.20210705.11

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AMA Style

Maitiu O. Tuathail. The Use of QT Prolongation Risk Factor Assessment Tool to Assess the Risk of QT Prolongation in Patients Taking Methadone: An Irish Experience. Eur J Clin Biomed Sci. 2021;7(5):75-80. doi: 10.11648/j.ejcbs.20210705.11

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@article{10.11648/j.ejcbs.20210705.11,
  author = {Maitiu O. Tuathail},
  title = {The Use of QT Prolongation Risk Factor Assessment Tool to Assess the Risk of QT Prolongation in Patients Taking Methadone: An Irish Experience},
  journal = {European Journal of Clinical and Biomedical Sciences},
  volume = {7},
  number = {5},
  pages = {75-80},
  doi = {10.11648/j.ejcbs.20210705.11},
  url = {https://doi.org/10.11648/j.ejcbs.20210705.11},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ejcbs.20210705.11},
  abstract = {Currently, no tool exists to assist doctors in estimating their patients’ risk of QT prolongation. Methadone is one of many medications which is known to prolong a patient’s QT, and which can lead to Torsades de Pointes and sudden cardiac death. The aim of the study was to design a QT prolongation risk factor assessment tool, for patients taking methadone, which would allow physicians to objectively assess a patient’s risk of QT prolongation. Following a literature review a QT prolongation risk factor assessment tool was created. An audit was then carried out to see what risk factors for QT prolongation were identified prior to use of the tool, in our practice, and then after the tool had been introduced. The introduction of a dedicated QT risk factor assessment tool led to an 61% (39/100 to 100/100) increase in the documentation of individual QT prolongation risk factors in our patients. There was a 100% (4/4) increase in the documentation of risk of QT prolongation in the patient notes, of discussion that risk with patients (4/4), and of the frequency of repeat ECGS (4/4). The introduction of such a QT prolongation risk factor assessment tool in our practice led to an increased awareness of QT prolonging medications, an improvement in the documentation of QT prolonging risk factors and a change in the culture of the practice around medication prescribing and QT prolongation. In patients who are on methadone, a QT prolongation risk factor assessment tool allows for an objective assessment of each patient’s risk of QT prolongation which then allows for measures to be put in place to monitor and address this risk.},
 year = {2021}
}

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TY  - JOUR
T1  - The Use of QT Prolongation Risk Factor Assessment Tool to Assess the Risk of QT Prolongation in Patients Taking Methadone: An Irish Experience
AU  - Maitiu O. Tuathail
Y1  - 2021/09/16
PY  - 2021
N1  - https://doi.org/10.11648/j.ejcbs.20210705.11
DO  - 10.11648/j.ejcbs.20210705.11
T2  - European Journal of Clinical and Biomedical Sciences
JF  - European Journal of Clinical and Biomedical Sciences
JO  - European Journal of Clinical and Biomedical Sciences
SP  - 75
EP  - 80
PB  - Science Publishing Group
SN  - 2575-5005
UR  - https://doi.org/10.11648/j.ejcbs.20210705.11
AB  - Currently, no tool exists to assist doctors in estimating their patients’ risk of QT prolongation. Methadone is one of many medications which is known to prolong a patient’s QT, and which can lead to Torsades de Pointes and sudden cardiac death. The aim of the study was to design a QT prolongation risk factor assessment tool, for patients taking methadone, which would allow physicians to objectively assess a patient’s risk of QT prolongation. Following a literature review a QT prolongation risk factor assessment tool was created. An audit was then carried out to see what risk factors for QT prolongation were identified prior to use of the tool, in our practice, and then after the tool had been introduced. The introduction of a dedicated QT risk factor assessment tool led to an 61% (39/100 to 100/100) increase in the documentation of individual QT prolongation risk factors in our patients. There was a 100% (4/4) increase in the documentation of risk of QT prolongation in the patient notes, of discussion that risk with patients (4/4), and of the frequency of repeat ECGS (4/4). The introduction of such a QT prolongation risk factor assessment tool in our practice led to an increased awareness of QT prolonging medications, an improvement in the documentation of QT prolonging risk factors and a change in the culture of the practice around medication prescribing and QT prolongation. In patients who are on methadone, a QT prolongation risk factor assessment tool allows for an objective assessment of each patient’s risk of QT prolongation which then allows for measures to be put in place to monitor and address this risk.
VL  - 7
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Author Information

Maitiu O. Tuathail

Irish College of General Practitioners, Dublin 2, Dublin, Ireland

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APA Style

Maitiu O. Tuathail. (2021). The Use of QT Prolongation Risk Factor Assessment Tool to Assess the Risk of QT Prolongation in Patients Taking Methadone: An Irish Experience. European Journal of Clinical and Biomedical Sciences, 7(5), 75-80. https://doi.org/10.11648/j.ejcbs.20210705.11

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ACS Style

Maitiu O. Tuathail. The Use of QT Prolongation Risk Factor Assessment Tool to Assess the Risk of QT Prolongation in Patients Taking Methadone: An Irish Experience. Eur. J. Clin. Biomed. Sci. 2021, 7(5), 75-80. doi: 10.11648/j.ejcbs.20210705.11

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AMA Style

Maitiu O. Tuathail. The Use of QT Prolongation Risk Factor Assessment Tool to Assess the Risk of QT Prolongation in Patients Taking Methadone: An Irish Experience. Eur J Clin Biomed Sci. 2021;7(5):75-80. doi: 10.11648/j.ejcbs.20210705.11

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@article{10.11648/j.ejcbs.20210705.11,
  author = {Maitiu O. Tuathail},
  title = {The Use of QT Prolongation Risk Factor Assessment Tool to Assess the Risk of QT Prolongation in Patients Taking Methadone: An Irish Experience},
  journal = {European Journal of Clinical and Biomedical Sciences},
  volume = {7},
  number = {5},
  pages = {75-80},
  doi = {10.11648/j.ejcbs.20210705.11},
  url = {https://doi.org/10.11648/j.ejcbs.20210705.11},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ejcbs.20210705.11},
  abstract = {Currently, no tool exists to assist doctors in estimating their patients’ risk of QT prolongation. Methadone is one of many medications which is known to prolong a patient’s QT, and which can lead to Torsades de Pointes and sudden cardiac death. The aim of the study was to design a QT prolongation risk factor assessment tool, for patients taking methadone, which would allow physicians to objectively assess a patient’s risk of QT prolongation. Following a literature review a QT prolongation risk factor assessment tool was created. An audit was then carried out to see what risk factors for QT prolongation were identified prior to use of the tool, in our practice, and then after the tool had been introduced. The introduction of a dedicated QT risk factor assessment tool led to an 61% (39/100 to 100/100) increase in the documentation of individual QT prolongation risk factors in our patients. There was a 100% (4/4) increase in the documentation of risk of QT prolongation in the patient notes, of discussion that risk with patients (4/4), and of the frequency of repeat ECGS (4/4). The introduction of such a QT prolongation risk factor assessment tool in our practice led to an increased awareness of QT prolonging medications, an improvement in the documentation of QT prolonging risk factors and a change in the culture of the practice around medication prescribing and QT prolongation. In patients who are on methadone, a QT prolongation risk factor assessment tool allows for an objective assessment of each patient’s risk of QT prolongation which then allows for measures to be put in place to monitor and address this risk.},
 year = {2021}
}

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TY  - JOUR
T1  - The Use of QT Prolongation Risk Factor Assessment Tool to Assess the Risk of QT Prolongation in Patients Taking Methadone: An Irish Experience
AU  - Maitiu O. Tuathail
Y1  - 2021/09/16
PY  - 2021
N1  - https://doi.org/10.11648/j.ejcbs.20210705.11
DO  - 10.11648/j.ejcbs.20210705.11
T2  - European Journal of Clinical and Biomedical Sciences
JF  - European Journal of Clinical and Biomedical Sciences
JO  - European Journal of Clinical and Biomedical Sciences
SP  - 75
EP  - 80
PB  - Science Publishing Group
SN  - 2575-5005
UR  - https://doi.org/10.11648/j.ejcbs.20210705.11
AB  - Currently, no tool exists to assist doctors in estimating their patients’ risk of QT prolongation. Methadone is one of many medications which is known to prolong a patient’s QT, and which can lead to Torsades de Pointes and sudden cardiac death. The aim of the study was to design a QT prolongation risk factor assessment tool, for patients taking methadone, which would allow physicians to objectively assess a patient’s risk of QT prolongation. Following a literature review a QT prolongation risk factor assessment tool was created. An audit was then carried out to see what risk factors for QT prolongation were identified prior to use of the tool, in our practice, and then after the tool had been introduced. The introduction of a dedicated QT risk factor assessment tool led to an 61% (39/100 to 100/100) increase in the documentation of individual QT prolongation risk factors in our patients. There was a 100% (4/4) increase in the documentation of risk of QT prolongation in the patient notes, of discussion that risk with patients (4/4), and of the frequency of repeat ECGS (4/4). The introduction of such a QT prolongation risk factor assessment tool in our practice led to an increased awareness of QT prolonging medications, an improvement in the documentation of QT prolonging risk factors and a change in the culture of the practice around medication prescribing and QT prolongation. In patients who are on methadone, a QT prolongation risk factor assessment tool allows for an objective assessment of each patient’s risk of QT prolongation which then allows for measures to be put in place to monitor and address this risk.
VL  - 7
IS  - 5
ER  -

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