title: Practice variation in the re-initiation of dofetilide: An observational study.
abstract: BACKGROUND
  Dofetilide is a class III antiarrhythmic drug that has been reported to be safe and efficacious in the treatment of atrial dysrhythmias with a known initial risk of QT prolongation and torsades de pointes (TdP). As a result, the Federal Drug Administration (FDA) mandated in-hospital dofetilide initiation and adherence to a common dosing protocol. However, there is a lack of clarity on how to manage dofetilide re-initiation.
  
  
  METHODS
  An observational survey was performed including 347 cardiologists in the United States and worldwide to evaluate the deviations from approved manufacturer's protocol during dofetilide initiation and re-initiation among practicing cardiologists.
  
  
  RESULTS
  Most practicing cardiologists were cautious about outpatient dofetilide use and adhered to the manufacturer's in-patient dofetilide protocol during de-novo initiation and reported low incidence of TdP in clinical practice. There were substantial differences among practicing cardiologists with deviation from the manufacturer's protocol during re-initiation of dofetilide. About 21% cardiologists always admitted patients to the hospital while 37% admitted patients <10% of the time for dofetilide re-initiation. Only 4% reported major adverse events with outpatient dofetilide re-initiation. There was also wide variation regarding monitoring of electrolytes and QT interval as an outpatient with dofetilide.
  
  
  CONCLUSIONS
  There is significant practice pattern variation in the use of dofetilide for the management of AF. This degree of variation noted is concerning and is a reflection of the current lack of substantial clinical evidence in the re-initiation dofetilide protocol to help direct the provider.
authors.affiliation: Division of Cardiovascular Medicine, University of Missouri Hospital and Clinics, Columbia, MO, United States.
authors.forename: Mohit K
authors.initials: MK
authors.lastname: Turagam
authors.affiliation: Division of Cardiovascular Diseases, Cardiovascular Research Institute, University of Kansas Hospital & Medical Center, Kansas City, KS, United States.
authors.forename: Muhammad R
authors.initials: MR
authors.lastname: Afzal
authors.affiliation: Division of Cardiovascular Diseases, Cardiovascular Research Institute, University of Kansas Hospital & Medical Center, Kansas City, KS, United States.
authors.forename: Madhu
authors.initials: M
authors.lastname: Reddy
authors.affiliation: Division of Cardiovascular Diseases, Cardiovascular Research Institute, University of Kansas Hospital & Medical Center, Kansas City, KS, United States.
authors.forename: Jayasree
authors.initials: J
authors.lastname: Pillarisetti
authors.affiliation: Division of Cardiovascular Diseases, Cardiovascular Research Institute, University of Kansas Hospital & Medical Center, Kansas City, KS, United States.
authors.forename: Madhav
authors.initials: M
authors.lastname: Lavu
authors.affiliation: Division of Cardiovascular Diseases, Cardiovascular Research Institute, University of Kansas Hospital & Medical Center, Kansas City, KS, United States.
authors.forename: Donita
authors.initials: D
authors.lastname: Atkins
authors.affiliation: Division of Cardiovascular Diseases, Cardiovascular Research Institute, University of Kansas Hospital & Medical Center, Kansas City, KS, United States.
authors.forename: Courtney
authors.initials: C
authors.lastname: Jeffrey
authors.affiliation: Division of Cardiovascular Diseases, Cardiovascular Research Institute, University of Kansas Hospital & Medical Center, Kansas City, KS, United States.
authors.forename: Katie
authors.initials: K
authors.lastname: Christensen
authors.affiliation: Division of Cardiovascular Diseases, Cardiovascular Research Institute, University of Kansas Hospital & Medical Center, Kansas City, KS, United States.
authors.forename: Rhea
authors.initials: R
authors.lastname: Pimentel
authors.affiliation: Division of Cardiovascular Diseases, Cardiovascular Research Institute, University of Kansas Hospital & Medical Center, Kansas City, KS, United States.
authors.forename: Raghuveer
authors.initials: R
authors.lastname: Dendi
authors.affiliation: Division of Cardiovascular Diseases, Cardiovascular Research Institute, University of Kansas Hospital & Medical Center, Kansas City, KS, United States.
authors.forename: James
authors.initials: J
authors.lastname: Vacek
authors.affiliation: North Texas Heart Center, 8440 Walnut Hill Lane, Suite 700, Dallas, TX 75231, United States.
authors.forename: Jodi
authors.initials: J
authors.lastname: Hurwitz
authors.affiliation: Albert Einstein College of Medicine, New York, NY, United States.
authors.forename: Luigi
authors.initials: L
authors.lastname: Di Biase
authors.affiliation: Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, United States.
authors.forename: Andrea
authors.initials: A
authors.lastname: Natale
authors.affiliation: Division of Cardiovascular Diseases, Cardiovascular Research Institute, University of Kansas Hospital & Medical Center, Kansas City, KS, United States. Electronic address: dlakkireddy@kumc.edu.
authors.forename: Dhanunjaya
authors.initials: D
authors.lastname: Lakkireddy
mesh_terms: D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000188:drug therapy*; D000072096:Cardiologists / Q000592:standards*; D006801:Humans; D010627:Phenethylamines / Q000627:therapeutic use*; D017410:Practice Guidelines as Topic / Q000592:standards*; D013449:Sulfonamides / Q000627:therapeutic use*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
chemical_list: D000889:Anti-Arrhythmia Agents; D010627:Phenethylamines; D013449:Sulfonamides; C063533:dofetilide
keywords: Antiarrhythmic drug; Atrial fibrillation; Dofetilide; Practice pattern; Survey; Tikosyn