Category: Federal Forum Posters
Purpose: Dofetilide is a class III antiarrhythmic medication that previously required a Risk Evaluation and Mitigation Strategy (REMS) program to ensure appropriate monitoring was completed. In 2016, the REMS program was removed; however, the monitoring of dofetilide remains necessary to reduce the risk of proarrhythmic effects and to avoid lapse in therapy. The primary objective of this project is to evaluate the impact of pharmacist involvement in monitoring dofetilide by identifying the number and type of interventions made in a dofetilide consult service.
Methods: In this retrospective chart review at the Chalmers P. Wylie Veterans Affairs (VA) Ambulatory Care Center, we identified 35 patients being treated with dofetilide. Completed progress notes were reviewed to assess the total number and specific types of interventions made by a pharmacist and the percentages of pharmacist’s interventions accepted by the providers. Types of interventions included dosage adjustments due to changes in renal function or EKG, electrolyte replacement recommendations, medication changes due to drug interactions, and referrals due to signs or symptoms of adverse effects. On average, EKG and lab work were assessed every three months, allowing pharmacists to regularly review medications, cardiac rhythms, and kidney function.
Results: During a mean follow-up of 8 months, a total 39 interventions were made by pharmacists. Interventions included assessment of drug interactions (19), renal adjustments (7), EKG changes (6), adherence (5), and electrolyte imbalance (2). Five patients were excluded due to either discontinuation of dofetilide before enrollment or having a baseline QTc above 500ms. Eight changes in therapy were implemented by providers including discontinuation of dofetilide due to QTc prolongation, discontinuation of other QTc prolonging medications, more frequent monitoring of lab work, and dosage adjustments based on renal function. The majority of interventions were identification of drug interactions that did not require discontinuation of therapy, but continued monitoring of EKGs for QTc prolongation. No serious adverse events were reported during the 8 months of follow-up.
Conclusion: Of the 30 patients analyzed, 19 patients benefitted directly from pharmacists’ interventions, while 11 patients did not require adjustments in therapy. While most interventions did not result in direct therapeutic changes, pharmacist intervention allowed for more complete monitoring and better communication between providers. The most common issues identified were drug interactions indicating risk of QTc prolongation; such interactions often required regular EKG monitoring versus medication discontinuation.
Regular review of medications and patient profiles by pharmacists can prevent complications and improve patient safety. Future studies could measure patient and provider satisfaction and financial savings from prevention of hospitalizations and long-term complications.
Brooke Espenschied– Pharmacy Resident, Chalmers P. Wylie Veterans Affairs Ambulatory Care Center, Hilliard, OH