Adherence to guidelines in monitoring amiodarone-induced thyroid dysfunction.

J Eval Clin Pract 2017 Feb 12;23(1):108-113. Epub 2016 Aug 12.

Division of Endocrinology and Metabolism, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.

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.

Download full-text PDF

Source
http://dx.doi.org/10.1111/jep.12619DOI Listing
February 2017
49 Reads

Publication Analysis

Top Keywords

thyroid function
24
baseline thyroid
12
function testing
8
function amiodarone
8
amiodarone usage
8
thyroid
8
follow-up thyroid
8
monitoring
6
amiodarone
6
function
6
referral centre
4
tertiary referral
4
enrolled cases
4
monitoring tertiary
4
1319 enrolled
4
centre arrhythmiamethods
4
arrhythmiamethods reviewed
4
analysedresults 1319
4
11% n = 15
4
monitoring assess
4

References

(Supplied by CrossRef)
Amiodarone and the thyroid
Basaria et al.
The American Journal of Medicine 2005
Effects of amiodarone therapy on thyroid function
Cohen-Lehman et al.
Nature Reviews Endocrinology 2010
Amiodarone: guidelines for use and monitoring
Siddoway et al.
American Family Physician 2003
A practical guide for clinicians who treat patients with amiodarone: 2007
Goldschlager et al.
Heart rhythm: the official journal of the Heart Rhthym Society 2007
Practical management guide for clinicians Who treat patients with amiodarone
Epstein et al.
The American Journal of Medicine 2016
Monitoring the use of amiodarone: compliance with guidelines
Burgess et al.
Internal Medicine Journal 2006

Similar Publications