title: Baseline and follow-up laboratory monitoring of cardiovascular medications.
abstract: BACKGROUND
  Laboratory monitoring of medications is typically used to establish safety prior to drug initiation and to detect drug-related injury following initiation. It is unclear whether black box warnings (BBWs) as well as evidence- and consensus-based clinical guidelines increase the likelihood of appropriate monitoring.
  
  
  OBJECTIVE
  To determine the proportion of patients newly initiated on selected cardiovascular medications with baseline assessment and follow-up laboratory monitoring and compare the prevalence of laboratory testing for drugs with and without BBWs and guidelines.
  
  
  METHODS
  This cross-sectional study included patients aged 18 years or older from a large multispecialty group practice who were prescribed a cardiovascular medication (angiotensin converting enzyme inhibitors, angiotensin II receptor blockers, amiodarone, digoxin, lipid-lowering agents, diuretics, and potassium supplements) between January 1 and July 31, 2008. The primary outcome measure was laboratory test ordering for baseline assessment and follow-up monitoring of newly initiated cardiovascular medications.
  
  
  RESULTS
  The number of new users of each study drug ranged from 49 to 1757 during the study period. Baseline laboratory test ordering across study drugs ranged from 37.4% to 94.8%, and follow-up laboratory test ordering ranged from 20.0% to 77.2%. Laboratory tests for drugs with baseline laboratory assessment recommendations in BBWs were more commonly ordered than for drugs without BBWs (86.4% vs 78.0%, p < 0.001). Drugs with follow-up monitoring recommendations in clinical guidelines had a lower prevalence of monitoring (33.1% vs 50.7%, p < 0.001).
  
  
  CONCLUSIONS
  Baseline assessment of cardiovascular medication monitoring is variable. Quality measurement of adherence to BBW recommendations may improve monitoring.
authors.affiliation: Department of Medicine, Division of Geriatric Medicine, University of Massachusetts Medical School, Worcester, MA, USA. Jennifer.Tjia@umassmed.edu
authors.forename: Jennifer
authors.initials: J
authors.lastname: Tjia
authors.forename: Shira H
authors.initials: SH
authors.lastname: Fischer
authors.forename: Marsha A
authors.initials: MA
authors.lastname: Raebel
authors.forename: Daniel
authors.initials: D
authors.lastname: Peterson
authors.forename: Yanfang
authors.initials: Y
authors.lastname: Zhao
authors.forename: Shawn J
authors.initials: SJ
authors.lastname: Gagne
authors.forename: Jerry H
authors.initials: JH
authors.lastname: Gurwitz
authors.forename: Terry S
authors.initials: TS
authors.lastname: Field
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002317:Cardiovascular Agents / Q000009:adverse effects / Q000627:therapeutic use*; D003430:Cross-Sectional Studies; D004348:Drug Labeling; D016903:Drug Monitoring / Q000379:methods* / Q000592:standards; D005260:Female; D005500:Follow-Up Studies; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D011787:Quality of Health Care; D055815:Young Adult
chemical_list: D002317:Cardiovascular Agents