Gopalani, Radhan

Lee, Joyce

Quadri, Faaria

English

Scholarly Commons@Baptist Health South Florida

Baptist Health South Florida Scholarly Commons @ Baptist Health South Florida All Publications 12-2019 Retrospective chart review of patients treated with ibutilide for pharmacological cardioversion Joyce Lee Baptist Hospital of Miami, joycel@baptisthealth.net Radhan Gopalani Baptist Hospital of Miami, radhang@baptisthealth.net Faaria Quadri Baptist Hospital of Miami, FaariaQ@baptisthealth.net Follow this and additional works at: https://scholarlycommons.baptisthealth.net/se-all-publications  Part of the Pharmacy and Pharmaceutical Sciences Commons Citation Lee, Joyce; Gopalani, Radhan; and Quadri, Faaria, "Retrospective chart review of patients treated with ibutilide for pharmacological cardioversion" (2019). All Publications. 3483. https://scholarlycommons.baptisthealth.net/se-all-publications/3483 This Conference Poster -- Open Access is brought to you for free and open access by Scholarly Commons @ Baptist Health South Florida. It has been accepted for inclusion in All Publications by an authorized administrator of Scholarly Commons @ Baptist Health South Florida. For more information, please contact Carrief@baptisthealth.net. PurposeTo assess the appropriateness of ibutilide use and to identify opportunities for optimal patient selection and monitoring per the FDA label and BHSF ibutilide protocol/ordersRetrospective chart review of patients treated with ibutilide for pharmacologic cardioversionArmando Mieres Pharm.D. Candidate; Caneel Marrero Pharm.D. Candidate; Joyce Lee, Pharm.D., BCCCP; Radhan Gopalani, Pharm.D., BCPS; Faaria Quadri, Pharm.D., BCPS; Baptist Hospital of Miami, Department of Pharmacy; Miami, FL• Atrial fibrillation (AF) is the most common cardiac arrhythmia• Ibutilide is a class III antiarrhythmic agent used to restorenormal sinus rhythm (NSR) in patients with AF and atrialflutter (AFL)• Compared to other antiarrhythmic agents, ibutilide has demonstrated similar or superior efficacy in clinical trials• Its use in AF and AFL is supported by guidelines with a class 1A recommendation• Risks associated with ibutilide include QT interval prolongation and torsades de pointes, especially in patients with electrolyte imbalances• A protocol for pharmacologic cardioversion has been established to facilitate safety and efficacy of ibutilide within Baptist Health South Florida (BHSF) hospitalsBackground Results Discussion• Ibutilide use at BHSF is consistent with current guidelines• Paroxysmal AF and AFL were more likely to convert to NSR with ibutilide• Opportunities for improvement:• Baseline electrolyte monitoring and replacement prior to ibutilide administration• Documentation of QT intervals• Staff education to enhance compliance with the established pharmacologic cardioversion protocol may further improve effectiveness and ensure safety of ibutilide in AF patientsReferences1) Corvert (ibutilide fumarate) [package insert]. New York, NY: Pharmacia & Upjohn Co; 2016.2) January CT, Wann LS, Alpert JS, et al. 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines and the Heart Rhythm Society. Circulation 2014; 130:e199.3) Nair M, George LK, Koshy SK.  Safety and efficacy of ibutilide in cardioversion of atrial flutter and fibrillation. J Am Board Fam Med 24.1 (2011): 86-92.DisclosuresAll authors have nothing to disclose concerning possible financial or nonfinancial personal relationships with commercial entities that may have direct or indirect interest in the subject matter of this presentation. Conclusion• Majority of patients (54/63) received ibutilide for cardioversion of AF• Forty-four (69.8%) with paroxysmal AF and 10 (15.9%) with persistent AF• Overall, 70% of patients successfully converted to NSR, requiring an average of 1.6 doses per patient• 17/44 patients required two doses for conversion to NSR• Baseline hypokalemia or hypomagnesemia was noted in 13/56 patients• Only 10/13 had electrolytes replenished• Although all patient were on continuous telemetry monitor, not all had QT interval consistently documented• QT prolongation was noted in 10 patients post-ibutilide, with 2/10 patients missing a baseline magnesium level• All patients (30/30) with CHA2DS2-VASc score of ≥ 2 were prescribed anticoagulation therapy upon dischargeLimitations• Small sample size• Inconsistent documentation of QT interval• Unable to establish clear risk factors for QT prolongation Primary EndpointMethods• Study Design• Multicenter, retrospective chart review• Per BHSF IRB, this review does not constitute human subjects research• Inclusion Criteria• Age ≥ 18 years• Administration of ibutilide between June 1st, 2018 and May 24th, 2019• Exclusion Criteria:  None• Primary Endpoint• Incidence of successful conversion to NSR• Secondary Endpoints• Electrolyte monitoring and replacement• Incidence of QT interval prolongation (QT interval ≥ 450 milliseconds)• Anticoagulation therapy based on CHA2DS2-VASc scoreSecondary EndpointsElectrolyte Management, n (%)• Electrolyte monitoring                                                         56/63 (89)• Required electrolyte replacement   13/56 (23.2) • Received electrolyte replacement    10/13 (76.9)QT Prolongation Post-Ibutilide, n (%)                                        10 (15.9)Anticoagulation Therapy, n (%)• CHA2DS2-VASc score of ≥ 2                                        30 (47.6)• Prescribed anticoagulation                                         30 (100)therapy upon dischargeUnsuccessful NSR Conversion19/63(30%)Successful NSR Conversion44/63(70%)Type of Arrhythmia Conversion Raten (%)Paroxysmal AF 36/44 (82)Persistent AF 2/10 (20)AFL 6/8 (75)Persistent Atrial Tachycardia0/1 (0)Baseline Characteristics           N = 63DemographicsMean age (range), years 7 (19 - 91)Mean weight (range), kg             93 (48 - 142)Male, n (%)                                   45 (71.4)Arrhythmia for > 48 hr, n (%)                          19 (30.2)Treatment Setting, n (%)Emergency Department                              Observation                                                   Inpatient14 (22.2)26 (41.3)23 (36.5)Arrhythmia, n (%)Paroxysmal Atrial Fibrillation 44 (69.8)Persistent Atrial Fibrillation 10 (15.9)Atrial Flutter                                             8 (12.7)Persistent Atrial Tachycardia            1 (1.6)Ibutilide Doses Administered, n (%)One                                                                  40 (46.5)               Two                                                                  23 (26.7)

Retrospective chart review of patients treated with ibutilide for pharmacological cardioversion

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Retrospective chart review of patients treated with ibutilide for pharmacological cardioversion

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