Safety of Inpatient Dofetilide Initiation per Cardiology Services: A
Retrospective Review
Abstract
Background Dofetilide is an antiarrhythmic medication that has the
potential to cause life threatening arrhythmias, such as Torsade de
pointes. The 2014 ACC/AHA/HRS guidelines for the management of patients
with atrial fibrillation state that patients need to meet certain
criteria to be initiated on dofetilide. Patients who are not initiated
on this therapy according to the guideline criteria are likely to be at
higher risk of adverse reactions. Methods This is a single center,
retrospective chart review of patients who were initiated on dofetilide
from July 2016-December 2019. Patients included in the study were
initiated on dofetilide as a new antiarrhythmic and monitored inpatient
for three days. The primary outcome was a composite of incidence of
cardiac arrhythmias, cardiac arrest, cardiac death, and cardiac related
hospital readmission. Results There were 224 patients included in the
analysis: 190 patients who were initiated on dofetilide inappropriately
and 34 that were initiated appropriately. The primary outcome (composite
of cardiac arrhythmia, cardiac arrest, cardiac death, and hospital
readmission) was statistically significant with more patients
experiencing an outcome in the group initiated inappropriately.
Discussion Patients are placed at a higher risk of adverse reactions
when this potentially dangerous antiarrhythmic medication is not used
according to the protocol set forth by the guidelines. Conclusion
Practitioners should use caution when prescribing dofetilide. Other
antiarrhythmic medications or non-pharmacologic options should be
considered due to the incidence of these dangerous adverse reactions.