The use of electronic notifications to improve guideline adherence in amiodarone adverse reaction monitoring

Abstract

Background:Amiodarone is an anti-arrhythmic drug that can cause side effects on the thyroid, liver, lungs, vision, and nervous system. Guidelines for monitoring and surveillance of these side effects have been in place since 2000, but adherence to them remains low in many countries,including Thailand. An electronic alert system has been implemented at Vajira Hospital,Navamindradhiraj University, Thailand, to remind physicians of the monitoring guideline since August 2023.

Objectives:This study aimed to compare adherence with the amiodarone guideline before and after implementing an electronic notification system and to evaluate the incidence of amiodarone-related adverse reactions.

Methods:This cohort study used electronic medical records of patients who visited the outpatient department at Vajira Hospital, Thailand, and received amiodarone for at least 1 month between February 2022 and February 2025. Adherence to the amiodarone guideline and incidence of adverse reactions were compared before and after implementing the electronic alert system in August 2023. The primary outcome was to compare adherence before and after the implementation of an electronic notification system. The secondary outcome was to assess the incidence of amiodarone-related side effects.

Results: We screened 201 patients who received amiodarone during that period, but only 110 patients received amiodarone continuously through the period of the electronic notification system(August 2023). The overall adherence to the amiodarone guideline increased from 11.8% to 46.4%(adjusted relative risk 3.92, 95% confidence interval [2.13–7.21]) following the implementation of the electronic alert system. Adherence to chest x-ray, liver function tests, and thyroid function tests also improved substantially after the intervention. The most common adverse reaction suspected from amiodarone usage was abnormal thyroid-stimulating hormone (TSH) levels. The incidence of abnormal TSH levels increased from 18.2% before the notification system to 23.6% after,although the difference was not significant.

Conclusion: The electronic alert system improved adherence to the guideline for monitoring amiodarone side effects in overall aspects. This intervention has the potential to enhance patient safety by facilitating the early detection of amiodarone-related adverse effects. We encourage the implementation of an electronic alert system in hospitals, particularly in the cardiology clinic, to monitor for potential amiodarone-related side effects.