Initial experience with antiarrhythmic medication monitoring by clinical pharmacists in an outpatient setting: A retrospective review

Snider, Melissa; Kalbfleisch, Steven J.; Carnes, Cynthia A.

doi:10.1016/j.clinthera.2009.06.014

Cited by 21 publications

(20 citation statements)

References 14 publications

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“…26 Collaboration with clinical pharmacists, computerized monitoring of testing, and automated alerts have been shown to improve rates of laboratory monitoring. 27–30 …”

Section: Discussionmentioning

confidence: 99%

Characterization of Mineralocorticoid Receptor Antagonist Therapy Initiation in High-Risk Patients With Heart Failure

Cooper

Hammill

Peterson

et al. 2017

Circ: Cardiovascular Quality and Outcomes

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Background Heart failure (HF) guidelines recommend routine monitoring of serum potassium and renal function in patients treated with a mineralocorticoid receptor antagonist (MRA). How these recommendations are implemented in high risk patients or according to setting of drug initiation is poorly characterized. Methods and Results We conducted a retrospective cohort study of Medicare beneficiaries linked to laboratory data in 10 states with prevalent HF as of July 1, 2011 and incident MRA use between May 1 and September 30, 2011. Outcomes included laboratory testing prior to MRA initiation and in the early (day 1–10) and extended (day 11–90) post-initiation periods, based on setting of drug initiation and presence of renal insufficiency. Additional outcomes included abnormal laboratory results and adverse events proximate to MRA initiation. Of 10,443 Medicare beneficiaries with HF started on an MRA, 19.7% were initiated during a hospitalization. Appropriate follow-up lab testing across all time periods occurred in 25.2% of patients with inpatient initiation compared with 2.8% of patients begun as an outpatient. Patients with chronic kidney disease (CKD) had higher rates of both hyperkalemia and acute kidney failure in the early (1.3% and 2.7%, respectively) and extended (5.6% and 9.8%, respectively) post-initiation periods compared with those without CKD. Conclusions Patients initiated on MRA therapy as an outpatient had extremely poor rates of guideline indicated follow-up laboratory monitoring after drug initiation. In particular, patients with CKD are at high risk for adverse events after MRA initiation. Quality improvement initiatives focused on systems to improve appropriate laboratory monitoring are needed.

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“…26 Collaboration with clinical pharmacists, computerized monitoring of testing, and automated alerts have been shown to improve rates of laboratory monitoring. 27–30 …”

Section: Discussionmentioning

confidence: 99%

Characterization of Mineralocorticoid Receptor Antagonist Therapy Initiation in High-Risk Patients With Heart Failure

Cooper

Hammill

Peterson

et al. 2017

Circ: Cardiovascular Quality and Outcomes

View full text Add to dashboard Cite

show abstract

“…Snider et al reported that the most common adverse events that were identified by the clinical pharmacists in their antiarrhythmic monitoring clinic were clinically significant drug interactions, the most frequent being amiodarone and high-dose simvastatin. 17 In the study by Karimi et al (2010) of a safety initiative for patients on concomitant amiodarone and simvastatin, 92 patients, representing 0.52% of simvastatin users, were using these medications concomitantly for an average of 43 months at a VA medical center. 21 Karimi et al did not assess adverse events, but a review of 30 clinical trials showed the rates of rhabdomyolysis for statins versus placebo to be 0.016% and 0.012%, respectively.…”

Section: ■■ Conclusionmentioning

confidence: 99%

“…17 Of a total of 134 patients enrolled in the clinic, 58 were receiving amiodarone and were monitored under protocols based on NASPE guidelines for amiodarone. The authors found that compliance with recommended monitoring tests for amiodarone improved from 20% before the first pharmacist-managed clinic visit to 100% after the initial visit.…”

Section: What This Study Addsmentioning

confidence: 99%

Evaluation of a Pharmacist-Managed Amiodarone Monitoring Program

Spence¹,

Polzin²,

Weisberger³

et al. 2011

JMCP

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“…7 The direct patient care costs of clinic services were based on averages calculated across all cost centers that charged the patient and included all direct fixed and variable expenses. Fixed clinic expenses included wages, benefits, utilities, and repairs and maintenance; variable expenses included drug costs, supplies, linens, and food.…”

Section: Methodsmentioning

confidence: 99%

“…5,6 Am J Health-Syst Pharm-Vol 69 Sep 15, 2012 Pharmacist-managed clinics for monitoring antiarrhythmic drug therapy provide improved care to patients by facilitating increased adherence to monitoring protocols and increased identification of adverse events and drug interactions. 7,8 As safety is considered a basic precept of any therapy, monitoring the use of these medications is extremely important. 9 Even with the use of the newest antiarrhythmic drug, dronedarone, monitoring is recommended.…”

mentioning

confidence: 99%