Students Research in Progress
Saturday, October 12, 2024
11:30 AM–01:00 PM
Abstract
Introduction:
Dofetilide and sotalol are medications for the management of cardiac arrhythmias and have a risk of inducing serious arrhythmias. Initiation of dofetilide and oral sotalol requires a minimum of three days admission in a facility capable of monitoring loading of these agents appropriately. Prior to admission these patients should be screened for safety and other prohibitive factors to drug load.
Research Question or Hypothesis: We aim to illustrate the necessity of involving a pharmacy team in the multidisciplinary process of loading a patient on dofetilide or sotalol at the University of Utah Health (UUH).
Study Design: Retrospective Chart Review
Methods: From May 1 to July 31, 2024, the UUH Electrophysiology team requested pharmacist review of patients’ charts prior to dofetilide and sotalol load. During this period the pharmacy team screened 20 patients. After the study period, a retrospective chart review was performed quantifying EKG concerns, dosing based on kidney function, appropriate anticoagulation, drug-drug interactions, disease-state contraindications, and cost of drug identified by the pharmacy team.
Results: Fifteen dofetilide and seven sotalol screenings were performed. Out of 20 patients, ten had EKG concerns such as QTc prolongation, AV nodal block, or no baseline EKG. Dofetilide and sotalol were contraindicated in two patients due to kidney function. Two patients were not appropriately anticoagulated. The largest number of recommendations came from drug-drug interaction screenings including diuretics, antiarrhythmics, antipsychotics, metformin, and mavacamten. Recommendations included discontinuing therapy or continuing therapy during antiarrhythmic drug load with appropriate monitoring. Sotalol was not recommended for one patient with uncontrolled COPD and another with worsening hypertrophic cardiomyopathy. Out of the 15 dofetilide screens, four patients had an estimated copay greater than $50 per month. Seventeen patients had at least one pharmacist intervention or recommendation.
Conclusion: In patients requiring cardioversion with dofetilide or sotalol, a pharmacy-driven screening process enhances safety and potentially decreases inappropriate admissions for antiarrhythmic drug loading.
Presenting Author
Rachel Fagergren PharmD CandidateUniversity of Utah Health and College of Pharmacy
Authors
Halie Anderson BS
Department of Pharmacotherapy, University of Utah Health, Salt Lake City, Utah
Jessica Carey PharmD
University of Utah Hospitals and Clinics
Halen Farmer PharmD Candidate
University of Utah Health and College of Pharmacy
Johanna Hernandez PharmD Candidate
University of Utah Health and College of Pharmacy
Grace Jondal PharmD Candidate
University of Utah Health and College of Pharmacy
Kristen Sommer PharmD Candidate
University of Utah Health and College of Pharmacy