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112 Amiodarone follow-up in ’tracker clinic’
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  1. Tm Tanzil-Al-Imran1,
  2. Lisa Yung1,
  3. Joshua Wilcox2
  1. 1Torbay and South Devon NHS Foundation Trust, Torquay, UK
  2. 2Kingston Hospital NHS Foundation Trust

Abstract

Amiodarone, a class III antiarrhythmic, one of the most widely used drugs for arrhythmia management. The common indications are rhythm control in AF/flutter (including peri-DCCV) in those with structural heart disease Post cardiac surgery, Ventricular arrhythmias, etc. However, it has a number of serious adverse effects including corneal microdeposits, optic neuropathy/neuritis, blue-gray skin discoloration, photosensitivity, hypothyroidism, hyperthyroidism, pulmonary toxicity, peripheral neuropathy, and hepatotoxicity. Therefore, amiodarone should be used with close follow-up. Some evidence suggests amiodarone is not monitored appropriately, less than one-third of Welsh study’s patients monitored for side effects, 13% and 17% of Scottish patients had no ALT or TSH testing in a retrospective analysis, 1413 patients, over 22 years, 27.3% of South Worcestershire patients had no thyroid function tests recorded over 5 years. The study also suggested that when randomized to a computerized system vs usual care, amiodarone baseline monitoring increased from 51 to 79%7. In Torbay and South Devon NHS Foundation Trust, the arrhythmia nurses follow up the patients for potential side effects who are on Amiodarone. We investigated the clinic follow-up process required for the patients who are on Amiodarone, the proportion of total arrhythmia nurse-led clinics were related to Amiodarone, the tests are done in the follow-up clinics, adverse effect identified, the outcome of the appointments. Between 2nd October 2019 to 27th December 2020, there were total of 562 appointments in arrhythmia nurse-led clinics. Amiodarone-related appointments were 17% (95 of 562). The mean age of the patient was 75 with a range of 40-93 and an SD of 9.9. The most common indication was AF 74.7%, Atrial Flutter 14.9%, and VT 10.3% (table 1). The mean duration of prescription was 272 days. Complications were noted in 14.7% of cases (14 of 95). Complications were related to the duration of treatment (no complication vs complications- 8.23 vs 11.33 months) (figure 2). 60% (57 of 95) outcomes were to continue ongoing monitoring of amiodarone (table 3). We have noticed 10%(57 of 562) of arrhythmia nurse-led clinics are related to Amiodarone monitoring only. A new setup for Amiodarone clinic titled ‘Amiodarone Tracker clinic’ is developed. An automated clinic letter will be generated 4 monthly requesting patients to provide a blood sample for renal function and liver function tests. One of the team members from Arrhythmia nurses will review the blood test results and will send a letter to the patient and his/her GP with the outcome. This ‘Tracker clinic will open up 10% of the face-to-face clinic appointments, reduce patient’s inconvenience for frequent visits to the hospital. There remains a question of clinical identification of adverse effects but effective patient education will subside the risk.

Abstract 112 Figure 1

Mean age of the patient was 75 with a range of 40-93 and SD of 9.9

Abstract 112 Figure 2

Most common indication was AF 74.7%, Atrial Flutter 14.9% and VT 10.3%

Abstract 112 Figure 3

The mean duration was 272 days (range 11-1095, SD. 271)

Abstract 112 Figure 4

The number of tests requested and checked at each appointment was analysed

Abstract 112 Figure 5

Complications of amiodarone prescription detected in 14 of 95 patients (1 patient had dyspnoea and hypothyroidism). Two thirds of all issues were to do with thyroid problems

Abstract 112 Figure 6

Complications of amiodarone according to the indication

Abstract 112 Figure 7

Median follow-up time was 4 months

Conflict of Interest No

  • Amiodarone
  • Follow-up
  • Clinic

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