Interventions Associated With Prospective Pharmacist Evaluation of Scheduled Admissions for Dofetilide Initiation

Background: Initiation of dofetilide requires hospital admission because of its proarrhythmic risk. To reduce the risk of adverse events associated with dofetilide, our institution has a standard operating protocol for dofetilide initiation. Regardless, patients are sometimes admitted for dofetilide initiation with unaddressed pharmacotherapy concerns that may delay therapy initiation and/or increase the risk for adverse events. Objective: To characterize interventions associated with pharmacist evaluation of scheduled dofetilide admissions prior to hospitalization. Methods: Patients scheduled for dofetilide initiation were evaluated by a pharmacist prior to admission. Identified interventions were categorized into the following recommendations: (1) against the use of dofetilide; (2) dofetilide starting dose adjustment; (3) appropriate washout of previous antiarrhythmic drug; (4) transesophageal echocardiogram prior to dofetilide initiation; (5) discontinuation or dose adjustment of interacting drug; (6) electrolyte supplementation upon discharge; (7) other intervention. The primary outcome measure was the frequency and types of identified and accepted interventions. Results: Twenty-two patients were evaluated during the 9-month study period. Fourteen interventions were identified, 13 of which were accepted by an electrophysiology provider. The most common intervention was for recommendation of a transesophageal echocardiogram prior to initiating dofetilide because of inadequate oral anticoagulation (n = 6). Other accepted interventions were for discontinuation or dose adjustment of interacting drug (n = 3), dofetilide starting dose adjustment (n = 2), electrolyte supplementation upon discharge (n = 2), and remeasurement of interventricular septal wall thickness (n = 1). Conclusion: Pharmacist evaluation of scheduled dofetilide admissions prior to hospitalization can serve to identify and resolve pharmacotherapy concerns related to dofetilide use.