Amiodarone is an effective antiarrhythmic agent with extended side-effects. It is therefore necessary to arrange appropriate, serial monitoring to prevent adverse effects. The purpose of this study was to quantify adherence to published recommendations for baseline monitoring when initiating amiodarone therapy and determine whether appropriate serial monitoring of chronic amiodarone therapy is occurring. Methods
A retrospective review of electronic medical records was conducted for outpatients who started amiodarone therapy at Chung Shan Medical University Hospital between July 1, 2005 and June 30, 2006. Their medical records were reviewed for demographic data reasons for, date of initiation of, and duration of amiodarone therapy and the occurrence of laboratory and diagnostic tests. The amiodarone guidelines from the North American Society of Pacing and Electrophysiology (NASPE) were 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). Results
Over the 1-year period from July 1, 2005 through June 30, 2006, 336 adult patients received amiodarone at Chung shan Medical University Hospital. These patients received baseline CXR, LFT , and TFT assessments were 57%, 41% and 7% respectively. However, none of the patients received baseline PFT assessments (diffusion lung capacity for carbon monoxide). Eighty-six(26%) patients received chronic amiodarone therapy for over one year. Baseline LFT, TFT, and CXR assessments occurred in 100%, 6% and 44% of these patients, respectively, and baseline PFT assessments were not performed in any of the patients. Follow-up monitoring at the recommended time intervals for LFTs and TFTs occurred in 22% and 18% of all of the patients, respectively, whereas annual CXRs were performed appropriately in 20% of the patients. Conclusions
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 and safety of amiodarone therapy.