The Use of Electronic Notifications to Improve Guideline Adherence in Amiodarone Adverse Reaction Monitoring

Background: Amiodarone is an antiarrhythmic drug that can cause side effects on the thyroid, liver, lungs, vision, and nervous system. Guidelines for monitoring and surveillance of these side effects have been established since 2000, but adherence to them is low in many countries including Thailand. An electronic alert system was implemented to remind physicians of the monitoring guideline at Vajira Hospital, Navamindradhiraj University, Thailand since 23 August 2023. Objective: This study aimed to compare adherence with the amiodarone guideline before and after implementing an electronic notification system (primary outcome) and to assess the incidence of amiodarone-related adverse reactions (secondary outcome). Methods: This study was a cohort study using electronic medical records of patients who visited the outpatient department at Vajira Hospital, Thailand and received amiodarone at least a month in the period between February 2022 to February 2025. Adherence with the amiodarone guideline and the incidence of adverse reactions before and after implementing the electronic alert system on 10 August 2023 were compared. Results: We screened 201 patients who received amiodarone in that period, but only 110 patients received amiodarone continuously through the period of the electronic notification system (8 august 2023). The overall adherence to the amiodarone guideline increased from 11.8% to 46.4% (adjusted RR 3.92, 95% CI 2.13-7.21) after the electronic alert system. Adherence to chest X-ray (CXR), liver function test (LFT), and thyroid function test (TFT) also improved significantly after the intervention. The most common adverse reaction suspected from amiodarone usage was abnormal thyroid stimulating hormone (TSH). The incidence of abnormal TSH was increased from 18.2% before to 23.6% after the notification system, although the difference didn’t reach statistical significance. (P value = 0.3780) Conclusion: The electronic alert system improved adherence to the guideline for monitoring amiodarone side effects in overall aspects. This intervention has the potential to enhance patient safety by facilitating early detection of amiodarone-related adverse effects. We encourage to implement of an electronic alert system in the hospital, especially in a cardiology clinic to monitor potential side effects from amiodarone.