Cardiac assessment for methadone prescribing: A clinical audit

First published: 10/05/2019 | Last updated: May 20th, 2019

Aims:

Methadone may be a risk factor for prolongation of QT interval and torsade de pointes. The Medicine and Healthcare Products Regulatory Agency (MHRA) recommended cardiac assessment and monitoring of patients on high dose of methadone (>100 mg daily) along with other risk factors associated with QT interval prolongation. This audit looks into the current clinical practice involving an assessment of cardiac conduction in patients on methadone substitution treatment with daily dose of 100 mg or higher.

Design:

‘Rotherham Alcohol and Substance Misuse Services’ provide services to the Rotherham district and its catchment areas.   The medical notes of all the patients in the above services who were prescribed on methadone 100 mg or more daily was reviewed.  Information on whether patient had undergone Electro Cardiogram (ECG) or recording of ECG report in the notes was acquired. In addition, we gathered data on co-morbid physical and mental illness and other medications.

Results:

Of the 56 service users identified, we were able to obtain the relevant data for 51 patients.  A total of 92 % (n=47) of the included patients had not undergone an ECG investigation. And 56% (n=29) of  patients had significant physical co-morbidity.

Conclusion: This finding highlights a gross deficit, compared to the national recommendations. Further, to the above results we have recommended some changes to improve the current practice. In collaboration with the Cardiology Department at the local  District General Hospital, a walk-in service for our clients to perform an ECG has been arranged.  We intend to conduct a re-audit after implementing these changes.

Mr Sudheer Lankappa