Department of Psychiatry, Emory University, School of Medicine, Decatur, GA 30033, USA.
J Addict Dis. 2010 Jan;29(1):15-22. doi: 10.1080/10550880903436044.
To improve the electrocardiogram screening process and early detection of patients at high risk for cardiac arrhythmias, the authors created a model in their clinic where they provided an onsite electrocardiogram screening that might be feasible and practical. The authors then performed a retrospective chart review to access the efficacy and feasibility of their new onsite procedure in identifying methadone maintained patients at high risk for cardiac arrhythmias. Records from all patients who are currently or had previously been maintained on methadone in the methadone maintenance program at the Atlanta VA Medical Center between 2002 and 2009 were evaluated. Of the 140 patients treated at the clinic between 2002 and 2009, 85 were excluded from the study because they had been treated as guests (had been in treatment in other clinics but received methadone dosing temporarily from our clinic), were treated in the clinic for less than 6 months, or dropped out of treatment. Thus, 55 patient charts were selected for review. Most patients (95%) received baseline and annual electrocardiogram screening. The average baseline QTc was (417 +/- 30) and most recent QTc (442 +/- 25). This QTc prolongation from baseline showed statistical significance (P < .0001). Sixty-seven percent of patients had statistically significant QTc prolongation from baseline but was less than 450 ms (mean: 428 +/- 16, P = .008). Twenty-seven percent of patients had statistically significant QTc prolongation from baseline of more 450 ms but was less than 500 ms (mean: 460 +/- 8, P < .0001). Six percent of patients had statistically significant QTc prolongation from baseline of more 500 ms (mean: 503 +/- 1.15, P = .027). Recent cocaine use was the only individual variable that showed statistically significant correlation with QTc prolongation (F = 6.98, P = .01). The authors demonstrated in this study that providing an onsite electrocardiogram screening with a focus on patient education and limiting the referral to specialty care for patients at high risk for cardiac arrhythmias could be practical and feasible.
为了改进心电图筛查流程并早期发现心律失常高危患者，作者在其诊所创建了一种模型，提供现场心电图筛查，这种方法可能具有可行性和实用性。作者随后进行了回顾性图表审查，以评估他们新的现场程序在识别美沙酮维持治疗患者心律失常高危风险方面的效果和可行性。评估了 2002 年至 2009 年间亚特兰大退伍军人事务医疗中心美沙酮维持治疗项目中目前或之前接受美沙酮维持治疗的所有患者的记录。在 2002 年至 2009 年期间在诊所接受治疗的 140 名患者中，有 85 名被排除在研究之外，因为他们被作为访客治疗（曾在其他诊所接受治疗，但从我们诊所临时接受美沙酮剂量），在诊所接受治疗的时间少于 6 个月，或退出治疗。因此，选择了 55 份患者图表进行审查。大多数患者（95%）接受了基线和年度心电图筛查。平均基线 QTc 为（417 +/- 30），最近的 QTc 为（442 +/- 25）。与基线相比，这种 QTc 延长具有统计学意义（P <.0001）。67%的患者与基线相比 QTc 延长有统计学意义，但小于 450 ms（平均：428 +/- 16，P =.008）。27%的患者与基线相比 QTc 延长大于 450 ms，但小于 500 ms（平均：460 +/- 8，P <.0001）。6%的患者与基线相比 QTc 延长大于 500 ms（平均：503 +/- 1.15，P =.027）。最近可卡因的使用是唯一与 QTc 延长有统计学显著相关性的个体变量（F = 6.98，P =.01）。作者在这项研究中表明，提供现场心电图筛查，重点是患者教育，并限制对心律失常高危患者的专科护理转诊，这可能是切实可行的。
