Evaluation of prescribing pattern of drugs use in patients of coronary artery disease at a tertiary care hospital

Authors

  • Mahesh N. Belhekar Department of Pharmacology, HBT Medical College and Dr. RN Cooper Municipal General Hospital, Mumbai, Maharashtra Province, India
  • Tejal C. Patel Department of Pharmacology, HBT Medical College and Dr. RN Cooper Municipal General Hospital, Mumbai, Maharashtra Province, India
  • Mohit Kumar Singh Department of Pharmacology, HBT Medical College and Dr. RN Cooper Municipal General Hospital, Mumbai, Maharashtra Province, India
  • Prasad R. Pandit Department of Pharmacology, HBT Medical College and Dr. RN Cooper Municipal General Hospital, Mumbai, Maharashtra Province, India
  • Kiran A. Bhave Department of Pharmacology, HBT Medical College and Dr. RN Cooper Municipal General Hospital, Mumbai, Maharashtra Province, India
  • Neelam N. Redkar Department of Medicine, HBT Medical College and Dr. RN Cooper Municipal General Hospital, Mumbai, Maharashtra Province, India

DOI:

https://doi.org/10.18203/2319-2003.ijbcp20183491

Keywords:

Myocardial infarction, Observational study, Prescription auditing, Secondary prevention

Abstract

Background: Coronary artery disease (CAD) is a major cause responsible for mortality more in younger age group than in elderly. Studies have reported underuse of four evidence based medicines namely aspirin, β-blockers, angiotensin-converting enzyme inhibitors (ACE-I) or angiotensin receptor blockers (ARB), and statins in patients with CAD, particularly in developing countries. Therefore, this study was planned to analyse the prescriptions of patients with CAD to determine the appropriateness of the prescriptions.

Methods: After obtaining the Institutional ethics committee permission, a cross sectional observational study was conducted at a tertiary care hospital. Total 150 patients were enrolled from the outpatient department, wards and intensive care unit of medicine department. Total 150 patients’ prescriptions presenting with varied category of CAD were screened and analysed.

Results: The most common categories of CAD encountered was ST segment elevated myocardial infarction (N=50, 33%) followed by chronic stable angina (N=29, 20%). Among the drugs prescribed, antiplatelet drugs were prescribed to 135 (90%), hypolipidemics to 134 (89%), nitrates to 114 (76%), beta blockers to 97 (65%), ACE inhibitors to 94 (64%), anticoagulants to 60 (40%) and miscellaneous drugs to 52 (35%), patients. Of 68 (45%) patients with type 2 diabetes mellitus, 15 (22%) were prescribed only metoprolol and others were given ACE-I or ARBs.

Conclusions: Among four evidence based drugs, use of 3 drugs, antiplatelets, beta blockers and hypolipidemics was apparent in 90% of prescriptions. Use of ACE inhibitors and ARBs was observed in type 2 diabetic patients with CAD, reflecting rational prescribing behavior of clinicians.

References

WHO 2016. Cardiovascular diseases (CVDs) Factsheet. Available at www.who.int/mediacentre/factsheets/fs317/en/.

Harikrishnan S, Leeder S, Huffman M, Jeemon P, Prabhakaran D. A race against Time: The challenge of cardiovascular disease in developing economies, centre for chronic disease control, New Delhi, India-2014.

Yusuf S, Rangarajan S, Teo K, Islam S, Li W, Liu L, et al. Cardiovascular risk and events in 17 low-, middle-, and high-income countries. N Eng J Med. 2014 Aug 28;371(9):818-27.

Prabhakaran D, Yusuf S, Mehta S, Pogue J, Avezum A, Budaj A, et al. Two-year outcomes in patients admitted with non-ST elevation acute coronary syndrome: results of the OASIS registry 1 and 2. Indian Heart J. 2005;57(3):217-25.

Global Atlas on cardiovascular disease prevention and control. Available at whqlibdoc.who.int/publications/2011/9789241564373_eng.pdf.

Prabhakaran D, Jeemon P, Roy A. Cardiovascular diseases in India: current epidemiology and future directions. Circulation. 2016 Apr 19;133(16):1605-20.

Sharma KK, Gupta R, Agrawal A, Roy S, Kasliwal A, Bana A, Tongia RK, Deedwania PC. Low use of statins and other coronary secondary prevention therapies in primary and secondary care in India. Vasc Health Risk Manag. 2009;5:1007.

Ajay VS, Prabhakaran D. Coronary heart disease in Indians: Implications of the INTERHEART study. Indian J Med Res. 2010 Nov;132(5):561-6.

WHO. How to Investigate Drug Use in Health Facilities: Selected Drug Use Indicators - EDM Research Series No. 007.1993. Available at http://apps.who.int/medicinedocs/en/d/Js2289e/4.4.html.

Rajanandh MG, Ramasamy CA. Imran khan. Pattern of cardiovascular drugs use in outpatients in a tertiary care hospital. Asian J Pharm Clin Res. 2012;5(1):109-112.

World Health Organization. Prevention of cardiovascular disease. Pocket guidelines for assessment and management of cardiovascular risk. 2012. WHO press, World Health Organization, Geneva 27, Switzerland. Available at: //Www.Ncbi.Nlm.Nih.Gov/Books/Nbk148602/Bin/Simplifiedtools-M1.Pdf.

Alam S, Naqvi BS, Alam S. A study of drug utilization in unstable angina/NSTEMI patients admitted in Karachi, Pakistan. World J Pharmaceut Res. 2015;4(5):13-22.

Dawalji S, Venkateshwarlu K, Thota S, Venisetty PK, Venisetty RK. Prescribing pattern in coronary artery disease: a prospective study. Int J Pharm Res Rev. 2014 Mar;3(3):24-33.

Patel R, Jawaid T, Shukla KP, Singh PM. Evaluation of drug utilization pattern in patient of myocardial infarction and prevalence of the MI by comparison of age, sex, diet, smokers and non-smokers, alcoholic and non-alcoholic. Am J Pharmacol Pharamacotherap. 2015;2 (1):72-80.

Sandozi T and Fouzia N. Drug utilization study in ischemic heart diseases associated with diabetes and hypertension. Int J Pharma Bio Sci. 2010;1(3):1-4.

Mendis S, Abegunde D, Yusuf S, Ebrahim S, Shaper G, Ghannem H, et al. WHO study on prevention of recurrences of myocardial infarction and stroke (WHO premise). Bulletin of the World Health Organization. 2005;83(11):820-8.

Choudhary P, Agrawal JM, Malhotra SD, Patel VJ. Drug utilization pattern in acute coronary syndrome at tertiary care hospital: a prospective cross-sectional observational study. Int J Basic Clin Pharmacol. 2016;5(2):513-6.

Thaker V, Patel K. A study of drug utilization pattern in post-acute coronary syndrome (ACS) patients at tertiary care teaching hospital: a prospective unicentric study. Int J Basic Clin Pharmacol. 2017 Jan;6(2):308-11.

Berger PB. Should proton pump inhibitors be withheld from patients taking clopidogrel? The issue that has been giving me heartburn!. Circ. Cardiovasc Qual Outcomes. 2015;8(1):6-7.

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Published

2018-08-23

How to Cite

Belhekar, M. N., Patel, T. C., Singh, M. K., Pandit, P. R., Bhave, K. A., & Redkar, N. N. (2018). Evaluation of prescribing pattern of drugs use in patients of coronary artery disease at a tertiary care hospital. International Journal of Basic & Clinical Pharmacology, 7(9), 1792–1796. https://doi.org/10.18203/2319-2003.ijbcp20183491

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Original Research Articles