Coordinating Medications for Women With Arrhythmia: Lindsey Valenzuela, PharmD

Women with arrhythmia often juggle multiple chronic conditions that increase the risk of drug interactions and fragmented care, according to Lindsey Valenzuela, PharmD, APh, BCACP, vice president of population health integration at Desert Oasis Healthcare.

In an interview with The American Journal of Managed Care^® (AJMC^®), Valenzuela said pharmacists play a critical role in preventing medication-related harm through robust reconciliation, deprescribing, and collaboration across specialties. She noted that women face unique cardiovascular differences, such as longer QT intervals, which make sex-specific management essential to reducing complications.

Building on her earlier points about access and detection, Valenzuela explains how pharmacists can bridge the communication gaps between care teams and ensure women with complex health profiles receive coordinated, safe, and affordable treatment.

This transcript has been lightly edited; captions were auto-generated.

Transcript

How should pharmacists and care teams approach medication management in women with arrhythmia and multiple comorbidities to avoid fragmented care?

This is such an interesting topic for me and very timely at the moment. There appears to be a correlation between the existence of chronic disease—such as diabetes, chronic kidney disease, obesity, COPD [chronic obstructive pulmonary disease]—and arrhythmias. And this makes polypharmacy a really big concern because many of those antiarrhythmics interact with the medications that we use to treat—antihypertensives, medications for diabetes, immunosuppressants—so that already complicates that issue with chronic disease.

We're really starting to look at who in the population might benefit from early surveillance, given the impact of chronic disease, to use these technologies earlier. And we're using AI [artificial intelligence] to pull those patients out of the chart so that there really isn’t any human ability to eliminate populations. Like we talked about in earlier questions, we want to make sure that it’s equitable across all socioeconomic areas, genders, and race and ethnic groups.

Very interesting topic of study, and what’s also interesting is that when you look at women, women aren’t just smaller men. There are natural differences between women and men cardiovascularly. Women naturally have a longer QT interval than men and are at risk for QT prolongation, bradycardia, and drug-induced arrhythmias. So, making sure that you approach that medication management in specific ways to women, knowing that their pathophysiology is different than men, is really key to keeping them safe.

The other thing is these chronic diseases are often treated in silos. The PCP [primary care provider] might manage hypertension, an endocrinologist might manage diabetes, the rheumatologist is dealing with the autoimmune conditions, and so there’s this opportunity for a lack of communication and collaboration, duplication of therapy, or lack of awareness of interactions that are happening with drug therapy. This is particularly concerning for women who have AFib [atrial fibrillation], as well as hypertension and diabetes, and have a higher stroke risk than men.

But pharmacists really are the drug experts, so regardless of the setting, pharmacists participating in care can do really robust medication reconciliation to avoid those risks of hypotension, bradycardia, QT prolongation, and they can help align the medication regimens and deprescribe to make adherence to medications more successful. We can bridge the gap when we’re looking at, for example, in our clinics, we have pharmacist-run clinics, things for just simple things like anticoagulation. We manage 100% of the patients on warfarin. As we’re doing medication reconciliation and visits for warfarin management, we can function as that communicator between the primary care and specialists to coordinate everybody’s understanding of the medication history and adherence and side effects.

This also allows us to address social and cost barriers. One of the biggest reasons we have pharmacists is to make sure that people have safe and effective access to medications, because we can prescribe them all day long, but if we don’t make sure that people can afford them, and start to take them and continue to take them, we will never be successful in the outcomes that we want.

I will endorse that a lot of this can be done at a much bigger scale if you really look at deploying things like remote patient monitoring tools—glucometers, blood pressure cuffs, scales, cardiac monitoring—that can be done to reduce the need for the patient to come in the office while improving their outcomes. I think pharmacists in any areas—whether it be outpatient, inpatient, medical groups—can really contribute by taking all that information in from the multiple different inputs from providers and sharing it so that not only are the providers aware but the patient’s aware.