TECHNOLOGY

Devices improve arrhythmia detection, glycemic control

Remote Monitoring for Diabetes, Heart Disease

Two studies presented at the American College of Clinical Pharmacy 2020 virtual annual meeting point to the power of mobile technology in helping patients with medication-induced heart problems and with diabetes.

The first project demonstrated that community pharmacists can make use of mobile ECG monitors to detect heart conduction abnormalities in their patients and alert prescribing physicians.

In a pilot study of 53 patients enrolled at three community pharmacies in Iowa, pharmacists used 30-second ECG measures recorded on a mobile device to study patients’ QTc intervals. All patients were taking medications known to be associated with prolonging the QTc interval, which can cause arrhythmia and result in fainting, seizures or sudden death. Based on QTc interval length calculated from the recordings, pharmacists contacted prescribers about potential drug-induced long QT syndrome in six patients (11% of the study sample). In three cases, prescribers made a medication change.

The technology could help “fill a big void” for pharmacists, said lead study author James Hoehns, PharmD, a clinical associate professor at the University of Iowa College of Pharmacy, in Iowa City, and the research director at the Northeast Iowa Medical Education Foundation, in Waterloo.

“Pharmacists have been working with these prescriptions, and making judgments about when to try and intervene and get somebody off of a medication, without actually knowing what their QTc interval is at that moment in time, which is really one of the elephants in the room,” Hoehns said. “Now, with this easy technology, we’ve got the ability for a pharmacist in 30 seconds to determine somebody’s QTc interval at the time they are processing this prescription. It’s put a totally new tool in the pocket of the pharmacist to help them with their professional judgment.”

More than 100 FDA-approved medications have a known ability to cause drug-induced long QT syndrome, he said, including commonly used drugs such as azithromycin, fluconazole, ciprofloxacin and escitalopram.

The study was conducted from July 2019 through March 2020. Patients’ mean age was 55.1 years, 38 (72%) were female, and 19 (36%) received newly prescribed medications that could prolong the QTc interval. The ECG measures were recorded on a personal ECG monitor made by KardiaMobile, for which patients place their fingers on a small device that uploads readings to a smartphone.

Researchers found no statistically significant differences between the community pharmacists’ calculations of QTc intervals and those done by family medicine physicians and cardiologists, using five sample recordings. In addition, Hoehns said, study participants responded well to the intervention. In a survey of 19 subjects, all said they agreed or strongly agreed that they were comfortable with the pharmacist obtaining their ECG recordings; that the pharmacist explained the test in a manner that was easy for them to understand; and that after talking with the pharmacist about the test, they felt safer taking a medication that could affect their heart.

The next step would be to conduct a randomized clinical trial to better measure the effectiveness of this tool against sites that don’t have it, Hoehns said.

Diabetes Monitoring

In the other study, researchers with Teladoc Health Inc. found that Livongo’s remote diabetes monitoring program (RDMP) with cellular-enabled glucose meters, test strips and coach interactions can improve both medication adherence and glycemic control.

Investigators noted that during two years of participation, medication adherence (measured as proportion of days covered) increased from 77% to 80% among 870 patients with diabetes enrolled in the program, but decreased from 78% to 69% among 479 matched controls not enrolled. Among RDMP members, each 10-day increase in days covered resulted in a 1-mg/dL decrease in blood glucose per month.

“We were pretty astonished to see this real difference at two years of medication adherence,” said Bimal Shah, MD, MBA, the chief medical officer of product and analytics at the company and a cardiologist with Duke University School of Medicine, in Durham, N.C. Previous studies showed that people with diabetes who are adherent to medications not only improve clinical outcomes but also save on health care costs over time because they are less likely to have major events such as heart attack, stroke or kidney disease, he said.

Patients enrolled in the RDMP program, usually offered through employer, national and regional health plans, are given a two-way cellular glucometer and unlimited testing strips, Shah said. Once a person takes a blood glucose reading, the information is sent to the program’s cloud-based analytics engine and is processed by a computerized algorithm that takes into account the person’s historical readings, medication list and other characteristics. Digital messages are then returned to the patient with tips to help them better manage blood glucose levels.

In addition, participants can set up oneon-one coaching appointments at any time with certified diabetes educators, through their glucometer, a web portal or a mobile app, Shah said. If any member registers an unusually high or low glucose reading for their history, one of the company’s diabetes response specialists will call within 90 seconds to walk through American Diabetes Association–recommended steps to get their blood glucose quickly back to a safe range. The program’s digital and human coaching features use member information to send reminders to take prescribed medications.

“We know that only about a third of people with diabetes are adherent to their medications on an ongoing basis,” Shah said. “This is a huge opportunity to promote better glucose control and better diabetes management.”

The KardiaMobile personal ECG monitor yields readings that can be uploaded to a smartphone and accessed by a caregiver for signs of arrhythmia. The Livongo remote diabetes monitoring program employs cellular-enabled glucose meters, test strips and coach interactions to help patients with glycemic control.

‘Pharmacists have been working with these prescriptions, and making judgments about when to try and intervene and get somebody off of a medication, without actually knowing what their QTc interval is at that moment in time, which is really one of the elephants in the room.’

—James Hoehns, PharmD

—Karen Blum

The University of Iowa College of Pharmacy study was sponsored by the Iowa Pharmacy Association Foundation. Hoehns reported no relevant fi nancial disclosures. Shah reported no relevant fi nancial disclosures other than his stated employment.