Assessment of hypothyroidism in patients with chronic heart failure

To determine whether appropriate thyroid function measurements were being conducted in patients receiving care at a multidisciplinary heart failure clinic.

Retrospective chart review.

University-affiliated outpatient clinic.

One hundred ninety-three patients with heart failure.

Patients enrolled in the heart failure clinic at the Medical University of South Carolina from January 2000-April 2003 were identified. Their medical records were reviewed for demographics, New York Heart Association (NYHA) functional classification, laboratory data, and date of most recent heart failure clinic appointment.

The records of 193 patients (43% women) were reviewed. Overall and subgroup analyses were performed based on patient characteristics such as presence of thyroid-stimulating hormone (TSH) level, interval since last heart failure clinic appointment, presence of thyroid replacement therapy, amiodarone use, NYHA functional class, and attending physician. Of the 193 patients, 77 (40%) had appropriate TSH monitoring, whereas 10 (32%) of 31 patients receiving amiodarone had appropriate monitoring. Forty-four (27%) patients not receiving amiodarone had no record of a TSH level. In 22 patients (11%), hypothyroidism was diagnosed and treated, whereas 16 patients (8%) had an abnormal TSH level but received no therapy.

Forty percent of the 193 patients at this outpatient heart failure clinic received appropriate TSH monitoring. An opportunity exists for protocol implementation and education of pharmacists, nurse practitioners, and physicians concerning appropriate thyroid function monitoring in the heart failure population.