Monitoring the use of amiodarone: compliance with guidelines

Burgess, Carl; Blaikie, Andrew; Ingham, Tristram; Robinson, Geoffrey; Narasimhan, Supriya

doi:10.1111/j.1445-5994.2006.01068.x

Cited by 22 publications

(13 citation statements)

References 15 publications

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“…Burges et al found that frequency of thyroid monitoring during amiodarone treatment is often inadequate, even though the relationship between the use of amiodarone and thyroid dysfunction has been known for years [31]. We therefore strongly recommend regular testing of thyroid function before, during and after administration of amiodarone.…”

Section: Discussionmentioning

confidence: 94%

Incidence and predictability of amiodarone-induced thyrotoxicosis and hypothyroidism

Hofmann

Nawara

Ofluoglu

et al. 2008

Wien Klin Wochenschr

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Section: Discussionmentioning

confidence: 94%

Incidence and predictability of amiodarone-induced thyrotoxicosis and hypothyroidism

Hofmann

Nawara

Ofluoglu

et al. 2008

Wien Klin Wochenschr

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“…Patients should have baseline LFTs and then periodic monitoring of LFTs while on amiodarone (at 1, 3, and 6 months and then semiannually) [62]. Studies have suggested that baseline LFTs monitoring is performed only in 44% of patients, and a follow-up testing at 6 months and 1 year is done in only 41% and 35% of patients, respectively [63]. Patients found to have asymptomatic elevation of transaminases while on amiodarone should have a thorough investigation of the cause [56]; repeated testing may be necessary before labeling diagnosis of amiodarone-induced hepatotoxicity [45].…”

Section: Discussionmentioning

confidence: 99%

Amiodarone-Induced Cirrhosis of Liver: What Predicts Mortality?

2013

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Introduction. Amiodarone has been used for more than 5 decades for the treatment of various tachyarrhythmias and previously for the treatment of refractory angina. There are multiple well-established side effects of amiodarone. However, amiodarone-induced cirrhosis (AIC) of liver is an underrecognized complication. Methods. A systematic search of Medline from January 1970 to November 2012 by using the following terms, amiodarone and cirrhosis, identified 37 reported cases of which 30 were used in this analysis. Patients were divided into 2 subsets, survivors versus nonsurvivors, at 5 months. Results. Aspartate aminotransferase was significantly lower (P = 0.03) in patients who survived at 5-months (mean 103.33 IU/L) compared to nonsurvivors (mean 216.88 IU/L). There was no statistical difference in the levels of prothrombin time, total bilirubin, alanine aminotransferase, alkaline phosphatase, gamma-glutamyl transpeptidase, cumulative dose, and latency period between the two groups. The prevalence of DM, HTN, HLD, CAD, and CHF was similar in the two groups. None of the above-mentioned variables could be identified as a predictor of survival at 5 months. Conclusion. AIC carries a mortality risk of 60% at 5 months once the diagnosis is established. Further prospective studies are needed to identify predictors of AIC and of mortality or survival in cases of AIC.

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“…Thereafter, thyroid function should be followed up every 6 months or sooner on the basis of clinical suspicion [5]. Despite clear recommendations from guidelines, thyroid monitoring in patients prescribed amiodarone have been suboptimal [11][12][13][14][15][16][17]. Conditions associated with more complete monitoring include patients with critical illness and enrollment in a pharmacist-managed amiodarone monitoring programme [15][16][17].…”

Section: Introductionmentioning

confidence: 99%

Adherence to guidelines in monitoring amiodarone‐induced thyroid dysfunction

Huang

Tseng

Chu

et al. 2016

Evaluation Clinical Practice

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Rationale, aims and objectives Baseline thyroid function testing and regular follow-up of thyroid function under amiodarone usage was recommended by guidelines. Little is known about the status of amiodarone monitoring in real-world clinical care in Taiwan. The objective was to determine the rate of thyroid monitoring and to assess the clinical and physicians' characteristics associated with adequate monitoring in a tertiary referral centre for arrhythmia. Methods We reviewed the medical records of patients receiving amiodarone during the period 2008-2009 at Taipei Veterans General Hospital. The rate of baseline and follow-up thyroid function monitoring during amiodarone therapy were calculated. Factors associated with guideline adherence to monitoring were analysed. Results Among the 1319 enrolled cases, 36.4% (n = 480) underwent baseline thyroid function testing and 1.1% (n = 15) received measurement of anti-thyroid peroxidase antibody before amiodarone initiation. Regular follow up of thyroid function under amiodarone usage occurred in only 8.6% (n = 114) of cases. Baseline thyroid function was more likely to be present in patients of younger age (P < 0.001), female sex (P = 0.01), and in those who received amiodarone therapy from cardiologists (P < 0.001) or electrophysiologists (P < 0.001) with fewer years of service (P < 0.001). Upon multivariate analysis, only physicians' expertise (cardiologist versus non-cardiologist, OR = 5.67, 95% CI: 2.44-13.16) and years of service (OR = 0.97, 95% CI: 0.95-0.998) were significantly associated with adequate thyroid monitoring. Conclusions The rate of thyroid monitoring with amiodarone therapy had been suboptimal. Strategies to enhance guideline adherence are needed.

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Monitoring the use of amiodarone: compliance with guidelines

Abstract: Monitoring of thyroid, liver and pulmonary function tests in patients on amiodarone is less than ideal. This is probably because of lack of awareness of current guidelines.

Cited by 22 publications

References 15 publications

Incidence and predictability of amiodarone-induced thyrotoxicosis and hypothyroidism

Incidence and predictability of amiodarone-induced thyrotoxicosis and hypothyroidism

Amiodarone-Induced Cirrhosis of Liver: What Predicts Mortality?

Adherence to guidelines in monitoring amiodarone‐induced thyroid dysfunction

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