Amiodarone Monitoring at a Tertiary Care Center in Saudi Arabia, Are We Adhering to the Published Guidelines?

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Naeem A. Alshoaibi


Amiodarone, Monitoring adherence, North American Society of Pacing and Electrophysiology Guidelines, Adverse effects, Toxicity


Objective: Baseline laboratory investigations and regular follow-up have been recommended by guidelines for patients receiving amiodarone. Our study evaluated adherence to the NASPE guidelines for monitoring patients who are prescribed amiodarone in a tertiary healthcare center in Saudi Arabia.
Methods: We randomly selected and retrospectively reviewed 387 patients receiving amiodarone from January 2014 and January 2019 at King Abdulaziz University Hospital in Jeddah, Saudi Arabia. Using the NASPE Guidelines for amiodarone monitoring, we evaluated which patients were appropiately monitored.
Results: Among the total 387 patients, 377 (97%) patients tested creatinine, 203 (52%) tested electrolytes, 343 (89%) tested thyroid function, 320 (83%) tested liver function, 12 (3%) had chest X-rays, 22 (6%) had pulmonary function tests, and none (0%) had an ophthalmic examination .
Amiodarone was taken for more than six months in 21 (5.4%) patients  of whom 19 (90%) had creatinine and electrolyte baselines tests, 11 (52%) tested baseline thyroid function, 18 (85%) tested baseline liver function, and 19 (90%) had a baseline chest X-ray. None of the patients had any pulmonary function testing or initial ophthalmic examination. Six-month follow-up on the same patients sample revealed out of 21 patients, 15 (71%) tested creatinine and electrolyte, 3 (14%) tested thyroid function, 17 (81%) tested liver function, 17 (81%) had chest X-ray, and none had follow-up pulmonary function tests or ophthalmic evaluation.
Conclusion: Our data showed very poor monitoring adherence to amiodarone, one of the most commonly used cardiac medication. A further study is required to measure the clinical impact of poor monitoring and provide a systematic protocol to ensure patients safety.

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