eScholarship@UMMS

Title

Baseline and Follow-up Laboratory Monitoring of Cardiovascular Medications

Authors

Jennifer Tjia, University of Massachusetts Medical SchoolFollow
Shira H. Fischer, University of Massachusetts Medical SchoolFollow
Marsha A. Raebel, Kaiser Permanente
Daniel J. Peterson, University of Massachusetts Medical SchoolFollow
Yanfang Zhao, University of Massachusetts Medical SchoolFollow
Shawn J. Gagne, University of Massachusetts Medical SchoolFollow
Jerry H. Gurwitz, University of Massachusetts Medical SchoolFollow
Terry S. Field, University of Massachusetts Medical SchoolFollow

Student Author(s)

Shira H. Fischer

UMMS Affiliation

Meyers Primary Care Institute; Department of Medicine, Division of Geriatric Medicine

Date

9-1-2011

Document Type

Article

Medical Subject Headings

Drug Monitoring; Pharmaceutical Preparations; Cardiovascular Agents; Safety Management

Disciplines

Health Services Research | Life Sciences | Medicine and Health Sciences

Abstract

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.

Rights and Permissions

Citation: Ann Pharmacother. 2011 Sep;45(9):1077-84. Epub 2011 Aug 18. Link to article on publisher's site

DOI of Published Version

10.1345/aph.1Q158

Related Resources

Link to Article in PubMed

Journal Title

The Annals of pharmacotherapy

PubMed ID

21852593

Repository Citation

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.
https://escholarship.umassmed.edu/gsbs_sp/1753