buprenorphine and Heart-Failure

The authors investigated whether patients receiving buprenorphine maintenance treatment (BMT) will have corrected QT (QTc) prolongation after taking buprenorphine for an extended period of time. They also compared QTc prolongation for patients in methadone maintenance treatment (MMT) versus BMT to determine which medication is the better option for patients with heart disease. A retrospective chart review study of 73 patients in BMT and 55 patients in MMT was performed. A linear regression model with a one-sided P value was used for data analysis. The MMT group had statistically significant prolongation of QTc compared with the BMT group (F = 3.94, P = .0001). Being diagnosed with congestive heart failure and taking methadone were the only individual variables that showed a statistically significant association with a QTc prolongation > 500 ms. The model as a whole showed statistical significance (F = 5.203, P = .007). Being diagnosed with congestive heart failure was the only individual variable that showed a statistically significant association with mortality. The model as a whole also showed statistical significance (F = 17.15, P = .000). This study supports previous findings that methadone may be associated with QTc prolongation, whereas buprenorphine may not. This study has the advantage of confirming that QTc prolongation persists in patients in MMT but not in those in BMT over an extended period of time (i.e., 5 years). Buprenorphine might a better first-line opioid maintenance treatment for patients with heart disease because buprenorphine was not associated with QTc prolongation. Patients in BMT may not need to be screened routinely for QTc prolongation.

Topics: Adult; Aged; Buprenorphine; Comorbidity; Dose-Response Relationship, Drug; Electrocardiography; Epidemiologic Methods; Female; Heart Failure; Humans; Long QT Syndrome; Male; Methadone; Middle Aged; Opiate Substitution Treatment; Opioid-Related Disorders; Outcome Assessment, Health Care; Time Factors

We report a 25-year-old Malay man with Subutex-related endocarditis, complicated by protein-losing enteropathy from severe tricuspid regurgitation and congestive heart failure. The intestinal protein loss was reversed with surgical valvular intervention. This case highlights the importance of recognising the rare association between protein-losing enteropathy and congestive heart failure in the setting of endocarditis.

Topics: Adult; Biopsy; Buprenorphine; Echocardiography, Doppler, Color; Echocardiography, Transesophageal; Endocarditis, Bacterial; Follow-Up Studies; Heart Failure; Heart Valve Prosthesis Implantation; Humans; Jejunum; Male; Mitral Valve Insufficiency; Narcotics; Postoperative Complications; Prosthesis Failure; Protein-Losing Enteropathies; Reoperation; Sepsis; Staphylococcal Infections; Substance Abuse, Intravenous; Surgical Wound Dehiscence; Tricuspid Valve Insufficiency