Cargando…

Multidisciplinary Management of Opioid Use–Related Infective Endocarditis: Treatment, QTc Values, and Cardiac Arrests due to Ventricular Fibrillation

(1) Background: The opioid epidemic has led to an increase in cardiac surgery for infective endocarditis (IE-CS) related to injection use of opioids (OUD) and other substances and a call for a coordinated approach to initiate substance use disorder treatment, including medication for OUD (MOUD), dur...

Descripción completa

Detalles Bibliográficos
Autores principales: Rosenfeld, Lynda E., Jain, Shashank, Amabile, Andrea, Geirsson, Arnar, Krane, Markus, Weimer, Melissa B.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9917424/
https://www.ncbi.nlm.nih.gov/pubmed/36769531
http://dx.doi.org/10.3390/jcm12030882
_version_ 1784886362815594496
author Rosenfeld, Lynda E.
Jain, Shashank
Amabile, Andrea
Geirsson, Arnar
Krane, Markus
Weimer, Melissa B.
author_facet Rosenfeld, Lynda E.
Jain, Shashank
Amabile, Andrea
Geirsson, Arnar
Krane, Markus
Weimer, Melissa B.
author_sort Rosenfeld, Lynda E.
collection PubMed
description (1) Background: The opioid epidemic has led to an increase in cardiac surgery for infective endocarditis (IE-CS) related to injection use of opioids (OUD) and other substances and a call for a coordinated approach to initiate substance use disorder treatment, including medication for OUD (MOUD), during IE-CS hospitalizations. We sought to determine the effects of the initiation of a multi-disciplinary endocarditis evaluation team (MEET) on MOUD use, electrocardiographic QTc measurements and cardiac arrests due to ventricular fibrillation (VF) in patients with OUD. (2) Methods and Results: A historical group undergoing IE-CS at Yale-New Haven Hospital prior to MEET initiation, Group I (43 episodes of IE-CS, 38 patients) was compared to 24 patients undergoing IE-CS after MEET involvement (Group II). Compared to Group l, Group II patients were more likely to receive MOUD (41.9 vs. 95.8%, p < 0.0001), predominantly methadone (41.9 vs. 79.2%, p = 0.0035) at discharge. Both groups had similar QTcs: approximately 30% of reviewed electrocardiograms had QTcs ≥ 470 ms and 17%, QTcs ≥ 500 ms. Cardiac arrests due to VF were not uncommon: Group I: 9.3% vs. Group II: 8.3%, p = 0.8914. Half occurred in the 1–2 months after surgery and were contributed to by pacemaker malfunction/ management and half were related to opioid use. (3) Conclusions: MEET was associated with increased MOUD (predominantly methadone) use during IE-CS hospitalizations without an increase in QTc prolongation or cardiac arrest due to VF compared to Group I, but events occurred in both groups. These arrests were associated with pacemaker issues or a return to opioid use. Robust follow-up of IE-CS patients is essential, as is further research to clarify the longer-term effects of MEET on outcomes.
format Online
Article
Text
id pubmed-9917424
institution National Center for Biotechnology Information
language English
publishDate 2023
publisher MDPI
record_format MEDLINE/PubMed
spelling pubmed-99174242023-02-11 Multidisciplinary Management of Opioid Use–Related Infective Endocarditis: Treatment, QTc Values, and Cardiac Arrests due to Ventricular Fibrillation Rosenfeld, Lynda E. Jain, Shashank Amabile, Andrea Geirsson, Arnar Krane, Markus Weimer, Melissa B. J Clin Med Article (1) Background: The opioid epidemic has led to an increase in cardiac surgery for infective endocarditis (IE-CS) related to injection use of opioids (OUD) and other substances and a call for a coordinated approach to initiate substance use disorder treatment, including medication for OUD (MOUD), during IE-CS hospitalizations. We sought to determine the effects of the initiation of a multi-disciplinary endocarditis evaluation team (MEET) on MOUD use, electrocardiographic QTc measurements and cardiac arrests due to ventricular fibrillation (VF) in patients with OUD. (2) Methods and Results: A historical group undergoing IE-CS at Yale-New Haven Hospital prior to MEET initiation, Group I (43 episodes of IE-CS, 38 patients) was compared to 24 patients undergoing IE-CS after MEET involvement (Group II). Compared to Group l, Group II patients were more likely to receive MOUD (41.9 vs. 95.8%, p < 0.0001), predominantly methadone (41.9 vs. 79.2%, p = 0.0035) at discharge. Both groups had similar QTcs: approximately 30% of reviewed electrocardiograms had QTcs ≥ 470 ms and 17%, QTcs ≥ 500 ms. Cardiac arrests due to VF were not uncommon: Group I: 9.3% vs. Group II: 8.3%, p = 0.8914. Half occurred in the 1–2 months after surgery and were contributed to by pacemaker malfunction/ management and half were related to opioid use. (3) Conclusions: MEET was associated with increased MOUD (predominantly methadone) use during IE-CS hospitalizations without an increase in QTc prolongation or cardiac arrest due to VF compared to Group I, but events occurred in both groups. These arrests were associated with pacemaker issues or a return to opioid use. Robust follow-up of IE-CS patients is essential, as is further research to clarify the longer-term effects of MEET on outcomes. MDPI 2023-01-22 /pmc/articles/PMC9917424/ /pubmed/36769531 http://dx.doi.org/10.3390/jcm12030882 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Rosenfeld, Lynda E.
Jain, Shashank
Amabile, Andrea
Geirsson, Arnar
Krane, Markus
Weimer, Melissa B.
Multidisciplinary Management of Opioid Use–Related Infective Endocarditis: Treatment, QTc Values, and Cardiac Arrests due to Ventricular Fibrillation
title Multidisciplinary Management of Opioid Use–Related Infective Endocarditis: Treatment, QTc Values, and Cardiac Arrests due to Ventricular Fibrillation
title_full Multidisciplinary Management of Opioid Use–Related Infective Endocarditis: Treatment, QTc Values, and Cardiac Arrests due to Ventricular Fibrillation
title_fullStr Multidisciplinary Management of Opioid Use–Related Infective Endocarditis: Treatment, QTc Values, and Cardiac Arrests due to Ventricular Fibrillation
title_full_unstemmed Multidisciplinary Management of Opioid Use–Related Infective Endocarditis: Treatment, QTc Values, and Cardiac Arrests due to Ventricular Fibrillation
title_short Multidisciplinary Management of Opioid Use–Related Infective Endocarditis: Treatment, QTc Values, and Cardiac Arrests due to Ventricular Fibrillation
title_sort multidisciplinary management of opioid use–related infective endocarditis: treatment, qtc values, and cardiac arrests due to ventricular fibrillation
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9917424/
https://www.ncbi.nlm.nih.gov/pubmed/36769531
http://dx.doi.org/10.3390/jcm12030882
work_keys_str_mv AT rosenfeldlyndae multidisciplinarymanagementofopioiduserelatedinfectiveendocarditistreatmentqtcvaluesandcardiacarrestsduetoventricularfibrillation
AT jainshashank multidisciplinarymanagementofopioiduserelatedinfectiveendocarditistreatmentqtcvaluesandcardiacarrestsduetoventricularfibrillation
AT amabileandrea multidisciplinarymanagementofopioiduserelatedinfectiveendocarditistreatmentqtcvaluesandcardiacarrestsduetoventricularfibrillation
AT geirssonarnar multidisciplinarymanagementofopioiduserelatedinfectiveendocarditistreatmentqtcvaluesandcardiacarrestsduetoventricularfibrillation
AT kranemarkus multidisciplinarymanagementofopioiduserelatedinfectiveendocarditistreatmentqtcvaluesandcardiacarrestsduetoventricularfibrillation
AT weimermelissab multidisciplinarymanagementofopioiduserelatedinfectiveendocarditistreatmentqtcvaluesandcardiacarrestsduetoventricularfibrillation