Assessment of drug utilization pattern and rationality of drug use in treatment of dilated cardiomyopathy in a tertiary care teaching hospital of rural Bengal

Authors

  • Prasun Banerjee Department of Pharmacology, Bankura Sammilani Medical College, Bankura, West Bengal, India
  • Ananya Mandal Department of Pharmacology, Bankura Sammilani Medical College, Bankura, West Bengal, India
  • Dipankar Mukhopadhyay Department of Pharmacology, Bankura Sammilani Medical College, Bankura, West Bengal, India
  • Tanmoy Gangopadhyay Department of Pharmacology, Bankura Sammilani Medical College, Bankura, West Bengal, India
  • Sonai Mandal Department of Pharmacology, Bankura Sammilani Medical College, Bankura, West Bengal, India
  • Abhijit Das Department of Pharmacology, Bankura Sammilani Medical College, Bankura, West Bengal, India

DOI:

https://doi.org/10.18203/2319-2003.ijbcp20164765

Keywords:

ACE inhibitors, Beta blockers, Dilated cardiomyopathy, Diuretics, Digoxin, Heart failure

Abstract

Background: Dilated cardiomyopathy (DCM) is an important underlying cause of congestive heart failure and/or arrhythmias. The introduction of therapy combining diuretics, digoxin and angiotensin converting enzyme inhibitors (ACEI) has significantly decreased mortality and morbidity. The aim of the study was undertaken to identify the pattern of drugs most commonly prescribed for DCM and to assess the rationality behind such use.

Methods: This was a prospective study undertaken between 1st July and 31st August 2015. Prescriptions were reviewed and analyzed using the World Health Organization (WHO) indicators for drug utilization studies. Rationality and cost of therapy per prescription was also evaluated.

Results: We encountered 78 patients of DCM in the OPD of Cardiology (prevalence of 4.94%). The average number of drugs per prescription was 6.64. Generic prescriptions were made in 90% encounters. As part of therapy, diuretics and ACE inhibitors or angiotensin receptor blockers, were prescribed in all cases. Our results show a distinctive drug use pattern where beta blockers were used more commonly than digoxin. Other commonly prescribed agents were antiplatelet drugs and statins. Antibiotics were prescribed in 8.7% cases and no injectable drug was prescribed. Average drug cost per encounter was 10.63 INR.

Conclusions: To conclude, we found a typical and rational pattern of drug use. Diuretics, ACEI and beta blockers were found to be most commonly used agents. This study provides a clear picture of drug use in this special clinical condition in rural Bengal and paves the way for larger and long term studies.

References

Ushashree B, Shivani V, Venkateshwari A, Jain RK, Narsimhan C, Nallari P. Epidemiology and genetics of dilated Cardiomyopathy in the Indian context. Indian J Med Sci. 2009;63:288-96.

Manolio TA, Baughman KL, Rodeheffer R. Prevalence and etiology of idiopathic dilated cardiomyopathy Am J Cardiol. 1992;69:1458-66.

Braunwald E, Zipes DP, Libby. Heart disease. A text book of cardiovascular medicine. 9th ed. Philadelphia. W.B. Saunders Company. 2012:1563-9.

World Health Organization Action Programme on Essential Drugs. How to investigate drug use in health facilities: selected drug use indicators. Available at: http://apps.who.int/medicinedocs/en/d/Js2289e/ (accessed on 10th September 2015).

ATC DDD Index. Available at: http://www.whocc.no/atc_ddd_index/ (accessed on 10th September 2015).

Deshmukh A, Deshmukh A, Deshmukh G, Garg PK. A pilot study of dilated cardiomyopathy (DCM) in western Uttar Pradesh, India: A four year review. Medico-Legal update. 2011:11. Available at: http://www.indianjournals.com/ijor.aspx?target=ijor:mlu&volume=11&issue=1&article=001. Accessed on 5th February 2016.

Rakar S, Sinagra G, Di Lenarda A, Poletti A, Bussani R, Silvestri F et al. Epidemiology of dilated cardiomyopathy: A prospective post-mortem study of 5252 necropsies. European Heart Journal. 1997;18:117-23.

Limas CJ, Limas C, Kubo SH, Olivari MT. Anti beta receptor antibodies in human dilated cardiomyopathy and correlation with HLA-DR antigens. Am J Cardiol. 1990;65:483-6.

Bharath DK, Chandrashekhar R, Manohar VR, Rai M, Gopalakrishna HN, Dsouza R. Drug Utilization study in patients with congestive cardiac failure in a South Indian tertiary care hospital: A retrospective study. Int Res J Pharm. 2015;6:463-6.

Baskota M, Rao BS, Shakya R. Study on the prescribing patterns of drugs used in heart failure. Kathmandu University Journal of Science, Engineering and Technology. 2006;2:1-10.

Margo KL, Luttermoser G, Shaughnessy AF. Spironolactone in Left-Sided Heart Failure: How Does It Fit In? Am Fam Physician. 2001;64:1393-9.

Yusuf S, Sleight P, Pogue J, Bosch J, Davies R, Dagenais G. Effects of an angiotensin-converting-enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients. The Heart Outcomes Prevention Evaluation Study Investigators. N Engl J Med. 2000;342:145-53.

Nair M, Sethi KK, Aggarwal R, Arora R, Khalilullah M. Clinical and hemodynamic effects of oral metoprolol in dilated cardiomyopathy. Indian Heart J. 1990;42:411-4.

Kurtoglu E, Balta S, Karakus Y, Yasar E, Cuglan B, Kaplan O, et al. Ivabradine Improves Heart Rate Variability in Patients with Nonischemic Dilated Cardiomyopathy. Arquivos Brasileiros de Cardiologia. 2014;103:308-14.

Busseuil D, Shi Y, Mecteau M, Brand G, Gillis MA, Thorin E, et al. Heart rate reduction by ivabradine reduces diastolic dysfunction and cardiac fibrosis. Cardiology. 2010;117:234-42.

Tardif JC, O'Meara E, Komajda M, Böhm M, Borer JS, Ford I, et al. SHIFT Investigators Effects of selective heart rate reduction with ivabradine on left ventricular remodelling and function: results from the SHIFT echocardiography substudy. Eur Heart J. 2011;32:2507-15.

Massin EK. Current Treatment of Dilated Cardiomyopathy. Tex Heart Inst J. 1991;18:41-9.

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Published

2016-12-24

How to Cite

Banerjee, P., Mandal, A., Mukhopadhyay, D., Gangopadhyay, T., Mandal, S., & Das, A. (2016). Assessment of drug utilization pattern and rationality of drug use in treatment of dilated cardiomyopathy in a tertiary care teaching hospital of rural Bengal. International Journal of Basic & Clinical Pharmacology, 6(1), 123–127. https://doi.org/10.18203/2319-2003.ijbcp20164765

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Original Research Articles