Title: Retrospective Evaluation of an Antiarrhythmic Monitoring Program
Authors: Kaitlin A Roberts, Rebecca Holt, Cynthia Pohland
Objective: Assess the James H Quillen Veterans’ Affairs Medical Center (JHQVAMC)’s adherence to monitoring recommendations for seven different antiarrhythmic medications (amiodarone, dronedarone, sotalol, dofetilide, mexiletine, propafenone, flecainide).
Self-Assessment Question: Which of the following antiarrhythmics showed significant improvement in adherence to monitoring recommendations between the 2022-2023 resident project and the current resident project? A. Dofetilide, B. Propafenone, C. Dronedarone, D. Flecainide
Background: The purpose of this quality improvement project was to evaluate the current compliance with antiarrhythmic drug (AAD) monitoring program collaboratively developed after a 2023 residency project identified low compliance with routine monitoring.
Methods: Participants were identified by presence of AAD prescription and eligibility was assessed. Patients receiving care at and prescribed an AAD at JHQVAMC between June 2024 – June 2025 were included. Participants were excluded if they were not prescribed an AAD by a VA provider. No more than 50 participants on each antiarrhythmic medication were randomly sampled and retrospectively reviewed to collect the following: demographics (age, sex, race/ethnicity); number of appointments with electrophysiology (EP) providers, non-EP cardiology providers, and cardiology pharmacists; frequency of lab monitoring (potassium (K), magnesium (Mg), liver function tests (LFTs), serum creatinine (SCr), thyroid stimulating hormone (TSH); and frequency of electrocardiograms (EKG). Results of descriptive statistics were used to evaluate compliance with monitoring. The results will then be disseminated to the local EP cardiology team to enhance current practice.
Result: Percentage of appropriate monitoring visits for dronedarone, sotalol, amiodarone, dofetilide, flecainide, mexiletine, and propafenone were 53%, 60%, 80%, 74%, 66%, 90%, and 80% respectively. Percentage of appropriate EKG monitoring for dronedarone, sotalol amiodarone, dofetilide, flecainide, mexiletine, and propafenone was 65%, 66%, 72%, 80%, 72%, 95%, and 80% respectively. The percentage of appropriately monitored labs was as follows: dronedarone had 58% K and LFTs, 16% Mg and TSH; sotalol had 84% K, 46% Mg, 88% SCr; amiodarone had 78% K, 24% Mg, 70% LFTs, 26% TSH; dofetilide had 94% K and SCr, 76% Mg; flecainide had 82% K, 20% Mg, 80% LFTs; mexiletine had 100% K and LFTs, 76% Mg; propafenone had 100% K and LFTs, 40% magnesium.
Conclusions: After pharmacist intervention, JHQVAMC was monitoring the majority of patients on AAD appropriately, with few exceptions that can be improved upon through process improvement such as the creation of lab order sets.
