RATIONALE, DEVELOPMENT, AND CLINICAL OUTCOMES OF A MULTIDISCIPLINARY AMIODARONE CLINIC

Objectives. To review the rationale and development of a multidiscipli nary amiodarone clinic, and document the clinical outcomes resulting f rom its implementation. Methods. A clinic was established to provide a n ambulatory setting in which patients receiving amiodarone could be f ollowed according to published guidelines by a multidisciplinary team of cardiovascular health care specialists. Patients receiving amiodaro ne were referred to the clinic by their primary physicians. A data bas e containing each patient's medical history, current drug therapy, and baseline laboratory values was developed during the initial visit. Li ver function tests, thyroid function tests, and chest radiographs were performed every 6 months, and pulmonary function tests were scheduled on an annual basis. Dosage adjustments were performed in select patie nts. Results. Since November 1996, 60 patients have been referred to t he amiodarone clinic. Mean length of follow-up before and after referr al was 16.3 +/- 25.5 and 9.2 +/- 5.5 months, respectively. Laboratory tests were performed according to accepted guidelines in 14 (23%) pati ents before referral compared with 54 (90%) patients after enrollment (p<0.001). Previously unrecognized adverse events were detected in 21 (35%) patients, including pulmonary fibrosis, QT prolongation, liver e nzyme elevation, hypothyroidism, hygerthyroidism, and asthma exacerbat ion Amiodarone was discontinued in six patients, four of whom had susp ected pulmonary toxicity. The dose of amiodarone was adjusted in 29 (4 8.4%) patients. Conclusion. Many patients receiving amiodarone are not being followed according to published recommendations, Implementation of a specialized, multidisciplinary amiodarone clinic improves outcom es by monitoring for early detection of drug-related toxicities and by facilitating proper dosage modifications.