DOI: http://dx.doi.org/10.18203/2319-2003.ijbcp20180101

Periodic evaluation of drug utilization in intensive coronary care unit patients in a tertiary care hospital

Sangeeta Nath Sharma, Rajendra Holla, Subramanyam K., Mangala Srinivas

Abstract


Background: A wide and gradual variation exists periodically in the patterns of pharmacotherapy among patients admitted with CVDs in CCU. Periodic evaluation of drug utilization in the CCU is necessary for optimization of health care system, proper use of resources and making prescription policy.

Methods: It was retrospective and prospective study. Study was carried out at Tertiary care hospital in Mangalore. Retrospective study period was from 1/07/2010 till 31/12/2010 and Prospective study duration was from 1/01/2016 till 30/06/2016. Patients from CCU were participants of this study.

Results: Data of total 278 patients were taken, out of which 138 patients from 2010 and 140 patients in 2016 were analyzed respectively and were compared among drug therapy for IHD - Nitrates, dual antiplatelet therapy (aspirin and clopidogrel), dyslipidemic drugs and beta blockers remain drug of choice in both retrospective and prospective study. But, anticoagulant (heparin/ LMWH) use increased in prospective studies. In Heart failure - nitrates, antiplatelet, dyslipidemic drugs followed by inotropes and diuretics was used in both study. Cardiomyopathy was managed with diuretics, ACEIs, and nitrates in both retrospective and prospective study.

Conclusions: In conclusion, predominance of male gender and poly-pharmacy were observed. However, it has identified areas to further rationalize and optimize patterns of polypharmacy and evidence based use of medications like beta blockers, anticoagulants/antiplatelet agents and antiarrythmisc. The results on the major determinants of cardiovascular drug use in CCU matched with the existing indications and cautions for use with each drug class.


Keywords


Arrhythmia, Cardiomyopathy, CCU, IHD, Polypharmacy

Full Text:

PDF

References


Wiholm BE, Westerholm B. Drug utilization and morbidity statistics for the evaluation of drug safety in Sweden. Acta Med Scand Suppl. 1984;683:107-17.

Dukes MN. Drug utilization studies. Methods and uses. Introduction. WHO Reg Publ Eur Ser. 1993;45:1-4.

Introduction to Drug Utilization Research: Preface: Drug utilization research - the early work [Internet]. [cited 2017 Oct 12]. Available at: http://apps.who.int/medicinedocs/en/d/Js4876e/1.html#Js4876e.1

Introduction to Drug Utilization Research: Chapter 1: What is drug utilization research and why is it needed?: 1.2 Why drug utilization research? [Internet]. [cited 2017 Oct 12]. Available at: http://apps.who.int/medicinedocs/en/d/Js4876e/2.2.html#Js4876e.2.2

Pendhari SR, Chaudhari DR, Burute SR, Bite BM. A study on the drug utilization trends in the cardiovascular emergencies in a tertiary care hospital. J Clin Diagn Res JCDR. 2013 Apr;7(4):666-70.

Evaluation of the Rationality of Fixed Dose Combinations of Cardiovascular drugs in a Multispecialty Tertiary care hospital in Coimbatore, Tamilnadu, India [Internet]. [cited 2017 Oct 12]. Available at: https://www.researchgate.net/publication/235950292_Evaluation_of_the_Rationality_of_Fixed_Dose_Combinations_of_Cardiovascular_drugs_in_a_Multispecialty_Tertiary_care_hospital_in_Coimbatore_Tamilnadu_India

Sokol MC, Mcguigan KA, Verbrugge RR, Epstein RS. Impact of medication adherence on hospitalization risk and healthcare cost. Med Care. 43(6):521-30.

BCS_Report_on_Coronary_Care_Units.pdf [Internet]. [cited 2017 Oct 13]. Available at: http://www.bcs.com/documents/BCS_Report_on_Coronary_Care_Units.pdf

Herrett E, Smeeth L, Walker L, Weston C. The Myocardial Ischaemia National Audit Project (MINAP). Heart. 2010 Aug;96(16):1264-7.

Birkhead JS, Weston C, Lowe D. Impact of specialty of admitting physician and type of hospital on care and outcome for myocardial infarction in England and Wales during 2004-5: observational study. BMJ. 2006 Jun 3;332(7553):1306-11.

brjclinpharm00013-0005.pdf [Internet]. [cited 2017 Oct 12]. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1364974/pdf/brjclinpharm00013-0005.pdf

Patel MK, Barvaliya MJ, Patel TK, Tripathi C. Drug utilization pattern in critical care unit in a tertiary care teaching hospital in India. Int J Crit Illn Inj Sci. 2013;3(4):250-5.

Nagabushan H, Roopadevi HS, Prakash GM, Pankaja R. A prospective study of drug utilization pattern in cardiac intensive care unit at a tertiary care teaching hospital. Int J Basic Clin Pharmacol. 2017 Jan 18;4(3):579-83.

Al-Junid SM, Ezat WPS, Surianti S. Prescribing patterns and drug cost among cardiovascular patients in Hospital Universiti Kebangsaan Malaysia. Med J Malaysia. 2007 Mar;62(1):59-65.

George J, Devi P, Kamath DY, Anthony N, Kunnoor NS, Sanil SS. Patterns and determinants of cardiovascular drug utilization in coronary care unit patients of a tertiary care hospital. J Cardiovasc Dis Res. 2013 Dec;4(4):214-21.

Classen DC, Pestotnik SL, Evans RS, Lloyd JF, Burke JP. Adverse Drug Events in Hospitalized Patients: Excess Length of Stay, Extra Costs, and Attributable Mortality. JAMA. 1997 Jan 22;277(4):301-6.

Shankar PR, Upadhyay DK, Subish P, Bhandari RB, Das B. Drug utilisation among older inpatients in a teaching hospital in Western Nepal. Singapore Med J. 2010 Jan;51(1):28-34.

Hedamba R, Doshi C, Darji NH, Patel B, Kumari V, Trivedi HR. Drug utilization pattern of antimicrobial drugs in intensive care unit of a tertiary care hospital attached with a medical college. Int J Basic Clin Pharmacol. 2016 Dec 24;5(1):169-72.

Rodgers A, Lawes C, MacMahon S. Reducing the global burden of blood pressure-related cardiovascular disease. J Hypertens Suppl Off J Int Soc Hypertens. 2000 May;18(1):S3-6.

Investigators TC in UA to PRET. Effects of Clopidogrel in Addition to Aspirin in Patients with Acute Coronary Syndromes without ST-Segment Elevation. N Engl J Med. 2001 Aug 16;345(7):494-502.

King SB, Smith SC, Hirshfeld JW, Jacobs AK, Morrison DA, Williams DO, et al. Focused Update of the ACC/AHA/SCAI 2005 Guideline Update for Percutaneous Coronary Intervention: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines: 2007 Writing Group to Review New Evidence and Update the ACC/AHA/SCAI 2005 Guideline Update for Percutaneous Coronary Intervention, Writing on Behalf of the 2005 Writing Committee. Circulation. 2008 Jan 15;117(2):261-95.