Point-of-care Electronic Medical Records Reminders Improve Adherence to Amiodarone Monitoring Guidelines
Document Type
Article
Abstract
Background: Amiodarone is a potent anti-arrhythmic agent that prevents recurrence of atrial fibrillation and ventricular arrhythmias. Despite relatively high efficacy, long term use of high doses of the medication is associated with multiple adverse reactions involving thyroid gland, liver, lungs, eye and skin. Non-adherence to guideline-based monitoring for amiodarone toxicity can potentially result in increased morbidity. We aimed to improve guideline-based monitoring of amiodarone toxicity using point-of-care electronic medical records reminders.
Methods: Patients who had received at least 6 months of amiodarone therapy were included. Baseline demographics, thyroid function test (TFT), liver function test (LFT), and chest X-rays were documented. The intervention was performed via a non-obtrusive, non-hard stop electronic reminder of the patient's most recent pertinent labs and chest X-ray which appeared next to the dosage when renewing prescription for amiodarone. Post-intervention data was documented and analyzed using the chi-squared test.
Results: A total of 212 patients were analyzed including 106 each in the pre- and post-intervention groups. In the baseline group 14 patients had their amiodarone discontinued secondary to complications. Thyroid dysfunction, pulmonary toxicity, and ophthalmological disease were the most common causes. Improvement was noted in ordering TFT (36% pre vs 59% post-intervention, p<0.001); LFT (58% pre- vs 75% post-intervention, p<0.05) and appropriate chest x-ray screening (65% pre- vs 79% post-intervention, p<0.05) over 5.3 months of observation.
Conclusion: Adherence to guideline-based screening tests for monitoring amiodarone toxicity can be augmented via a non-obtrusive electronic reminder of the most recent labs. Longer-term monitoring of adherence parameters is needed in order to evaluate the impact of this intervention on amiodarone-associated adverse reactions.
First Page
2614
DOI
10.1016/S0735-1097(24)04604-7
Publication Date
4-2-2024
Recommended Citation
Krinock M, Amaratunga EA, Roma N, Schwartz R, Desai S, Ma Z, Sheikh T, Shirani J. POINT-OF-CARE ELECTRONIC MEDICAL RECORDS REMINDERS IMPROVE ADHERENCE TO AMIODARONE MONITORING GUIDELINES. Journal of the American College of Cardiology. 2024 Apr 2;83(13_Supplement):2614-.