Adherence to the NASPE guideline for amiodarone monitoring at a medical university.

Abstract

Amiodarone is an effective antiarrhythmic, but the clinical usefulness of this agent is complicated by its extensive side-effect profile, which necessitates careful patient selection and frequent monitoring. The purpose of this study was to quantify adherence to published recommendations for baseline monitoring when initiating inpatient amiodarone therapy at a university teaching hospital and determine whether appropriate serial monitoring of chronic amiodarone therapy (>or= 6 months) is occurring in the outpatient setting. A retrospective review of electronic medical records was conducted for inpatients at the Medical University of South Carolina (MUSC) who received amiodarone between November 1, 2003, and March 31, 2004, and for a subset of outpatients who had received amiodarone therapy for at least 6 months. Their medical records were reviewed for demographic data; reason for, date of initiation of, and duration of amiodarone therapy; and the occurrence of laboratory and diagnostic tests. The amiodarone guideline from the North American Society of Pacing and Electrophysiology (NASPE) was used as the measure of appropriate monitoring for baseline and follow-up chest x-rays (CXRs), liver function tests (LFTs), thyroid function tests (TFTs), and pulmonary function tests (PFTs). Over the 5-month period from November 1, 2003, through March 31, 2004, 277 adult patients received oral amiodarone as inpatients at MUSC. Of these, 45 patients (16%) were initiated on chronic amiodarone therapy during their hospital admission. Baseline assessments of CXRs, LFTs, and TFTs occurred in 82% to 87% of these patients. Baseline assessment of PFTs occurred in 24% of patients, and 55% of these assessments included a diffusion capacity (DLCO). Overall, only 5 (11%) of the 45 patients initiated on amiodarone received all recommended monitoring tests. Twenty patients with available outpatient records in the MUSC system were identified as receiving chronic amiodarone therapy. Baseline assessments of LFTs, TFTs, and CXRs occurred in approximately 75% to 95% of these patients; baseline assessment of PFTs occurred in <or= 30%, and 83% of these included a DLCO. Chronic monitoring at recommended time intervals for LFTs and TFTs occurred in 35% and 20% of patients, respectively, whereas annual CXRs were performed appropriately in 50% of patients. Our data suggest that opportunities exist for improved monitoring of amiodarone therapy according to the NASPE guidelines and provide support for the development of a protocol to ensure continuous amiodarone monitoring.