Patients with congestive heart failure (CHF) often are treated with amiodarone for ventricular or atrial arrhythmias. This agent is often preferred due to its purported lack of hemodynamic effects, however other toxicities may occur. Therefore, routine monitoring of lung, thyroid, and liver function is recommended. Sanoski CA, et al previously reported that laboratory tests were performed according to accepted guidelines in 23% of patients before referral to an amiodarone clinic compared to 90% after referral. OBJECTIVE: To establish the role for a formal amiodarone monitoring program in a multidisciplinary CHF clinic. METHODS: After identifying which patients were taking amiodarone, a retrospective chart review was used to determine baseline adherence to national guidelines for performance of chest x-rays, thyroid and liver function. RESULTS: Of the 450 patients in the clinic, 47 were taking amiodarone. Thirty-two patients were male and 15 female with an average age of 69 + 13 years (53% ischemic). Indication for amiodarone therapy: 60% atrial fibrillation/flutter, 21% ventricular tachycardia, 13% sudden death, 6% unknown. The chart review period was 18.7 + 16.5 months. Baseline analysis revealed annual chest x-ray in 42.5% of cases; semiannual thyroid function in 25%; and semiannual liver function in 40%. Of the 29 patients still taking amiodarone, 52% did not have a chest x-ray in the previous 12 months, 52% and 34% did not have thyroid or liver function test, respectively in the previous 6 months. CONCLUSIONS: Patient safety from amiodarone toxic effects is of high concern. Despite national guidelines and a high prevalence of use, we found that over half of the patients receiving amiodarone therapy were not being monitored appropriately for toxicity. We conclude that there is need for a formal amiodarone monitoring program in this setting. We have designed and are testing a chart reminder system to address this deficit.