Baseline and Follow-up Laboratory Monitoring of Cardiovascular Medications
Meyers Primary Care Institute; Department of Medicine, Division of Geriatric Medicine
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.
DOI of Published Version
Ann Pharmacother. 2011 Sep;45(9):1077-84. Epub 2011 Aug 18. Link to article on publisher's site
The Annals of pharmacotherapy
Tjia J, Fischer SH, Raebel MA, Peterson DJ, Zhao Y, Gagne SJ, Gurwitz JH, Field TS. (2011). Baseline and Follow-up Laboratory Monitoring of Cardiovascular Medications. GSBS Student Publications. https://doi.org/10.1345/aph.1Q158. Retrieved from https://escholarship.umassmed.edu/gsbs_sp/1753