Bickford Courtney L, Spencer Anne P
MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 90, Houston, TX 77030, USA.
J Manag Care Pharm. 2006 Apr;12(3):254-9. doi: 10.18553/jmcp.2006.12.3.254.
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.
胺碘酮是一种有效的抗心律失常药物，但其广泛的副作用使该药物的临床应用变得复杂，这就需要谨慎选择患者并进行频繁监测。本研究的目的是量化在一所大学教学医院开始住院胺碘酮治疗时遵循已发表的基线监测建议的情况，并确定在门诊环境中是否对慢性胺碘酮治疗（≥6个月）进行了适当的连续监测。
对南卡罗来纳医科大学（MUSC）在2003年11月1日至2004年3月31日期间接受胺碘酮治疗的住院患者以及一部分接受胺碘酮治疗至少6个月的门诊患者的电子病历进行回顾性审查。审查他们的病历以获取人口统计学数据、胺碘酮治疗的原因、开始日期和持续时间以及实验室和诊断检查的情况。使用北美心脏起搏和电生理学会（NASPE）的胺碘酮指南作为基线和随访胸部X线（CXR）、肝功能检查（LFT）、甲状腺功能检查（TFT）和肺功能检查（PFT）适当监测的衡量标准。
在2003年11月1日至2004年3月31日的5个月期间，277名成年患者在MUSC作为住院患者接受了口服胺碘酮治疗。其中，45名患者（16%）在住院期间开始接受慢性胺碘酮治疗。这些患者中82%至87%进行了CXR、LFT和TFT的基线评估。24%的患者进行了PFT的基线评估，其中55%的评估包括弥散功能（DLCO）。总体而言，45名开始使用胺碘酮治疗的患者中只有5名（11%）接受了所有推荐的监测检查。在MUSC系统中确定有可用门诊记录的20名患者正在接受慢性胺碘酮治疗。这些患者中约75%至95%进行了LFT、TFT和CXR的基线评估；PFT的基线评估发生率≤30%，其中83%包括DLCO。分别有35%和20%的患者按照推荐的时间间隔对LFT和TFT进行了慢性监测，而50%的患者适当地进行了年度CXR检查。
我们的数据表明，根据NASPE指南，存在改善胺碘酮治疗监测的机会，并为制定确保持续胺碘酮监测的方案提供了支持。
