Baseline and Follow-up Laboratory Monitoring of Cardiovascular Medications
Clinical & Population Health Research Program
Meyers Primary Care Institute; Department of Medicine, Division of Geriatric Medicine
Medical Subject Headings
Drug Monitoring; Pharmaceutical Preparations; Cardiovascular Agents; Safety Management
Health Services Research | Life Sciences | Medicine and Health Sciences
BACKGROUND: Laboratory monitoring of medications is typically used to establish safety prior to drug initiation and to detect drug-related injury following initiation. It is unclear whether black box warnings (BBWs) as well as evidence- and consensus-based clinical guidelines increase the likelihood of appropriate monitoring.
OBJECTIVE: To determine the proportion of patients newly initiated on selected cardiovascular medications with baseline assessment and follow-up laboratory monitoring and compare the prevalence of laboratory testing for drugs with and without BBWs and guidelines.
METHODS: This cross-sectional study included patients aged 18 years or older from a large multispecialty group practice who were prescribed a cardiovascular medication (angiotensin converting enzyme inhibitors, angiotensin II receptor blockers, amiodarone, digoxin, lipid-lowering agents, diuretics, and potassium supplements) between January 1 and July 31, 2008. The primary outcome measure was laboratory test ordering for baseline assessment and follow-up monitoring of newly initiated cardiovascular medications.
RESULTS: The number of new users of each study drug ranged from 49 to 1757 during the study period. Baseline laboratory test ordering across study drugs ranged from 37.4% to 94.8%, and follow-up laboratory test ordering ranged from 20.0% to 77.2%. Laboratory tests for drugs with baseline laboratory assessment recommendations in BBWs were more commonly ordered than for drugs without BBWs (86.4% vs 78.0%, p < 0.001). Drugs with follow-up monitoring recommendations in clinical guidelines had a lower prevalence of monitoring (33.1% vs 50.7%, p < 0.001).
CONCLUSIONS: Baseline assessment of cardiovascular medication monitoring is variable. Quality measurement of adherence to BBW recommendations may improve monitoring.
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Citation: Ann Pharmacother. 2011 Sep;45(9):1077-84. Epub 2011 Aug 18. Link to article on publisher's site
Tjia, Jennifer; Fischer, Shira H.; Raebel, Marsha A.; Peterson, Daniel J.; Zhao, Yanfang; Gagne, Shawn J.; Gurwitz, Jerry H.; and Field, Terry S., "Baseline and Follow-up Laboratory Monitoring of Cardiovascular Medications" (2011). GSBS Student Publications. 1753.