Drug utilization pattern of cardiovascular medications and assessment of WHO-INRUD prescribing indicators among geriatric patients in a tertiary care hospital: a cross-sectional study
DOI:
https://doi.org/10.18203/2319-2003.ijbcp20262868Keywords:
Cardiovascular diseases, Drug utilization, Geriatric patients, WHO-INRUD indicatorsAbstract
Background: Cardiovascular disorders are a major cause of morbidity and mortality among older patients. Drug utilization studies are useful in assessment of prescribing behaviour and rational use of drugs. To study the drug utilization pattern of cardiovascular drugs and to evaluate the prescribing practices by WHO-INRUD prescribing indicators in geriatric patients of cardiovascular illnesses admitted in tertiary care hospital.
Methods: A hospital based observational cross-sectional study was carried out in Medicine wards and Intensive Care Unit of MGM Hospital, Navi Mumbai from April 2024 to March 2026. A total of 250 patients ≥65 years with cardiovascular illnesses were involved. The data were acquired from patient files, medication administration records and laboratory reports. The descriptive statistics were used to analyse drug consumption patterns and WHO-INRUD prescribing indicators.
Results: Of 250 patients, 62.4% were males and 37.6% females. The mean age was 70.88±4.00 years. The most prevalent cardiovascular disease was hypertension (87.6%), followed by ischemic heart disease (27.2%) and heart failure (11.2%). The most common pharmacological class used was calcium channel blockers (24.8%), followed by antiplatelet medicines (24.1%). 30.02% medications were prescribed generically and 51.69% drugs were prescribed from national list of essential medicines. Antibiotic and injectable prescriptions were written for 20.03% and 29.17% of encounters, respectively.
Conclusions: Hypertension was the most frequent cardiovascular illness among geriatric people. Moderate generic prescribing and compliance with NLEM suggest the necessity of regular prescription audits for promoting rational drug use.
Metrics
References
World Health Organization. Cardiovascular diseases (CVDs). Geneva: WHO. 2021.
Roth GA, Mensah GA, Johnson CO, Addolorato G, Ammirati E, Baddour LM, et al. Global burden of cardiovascular diseases and risk factors, 1990–2019: update from the GBD 2019 study. J Am Coll Cardiol. 2020;76(25):2982–3021. DOI: https://doi.org/10.1016/j.jacc.2020.11.010
World Health Organization. Introduction to drug utilization research. Geneva. WHO; 2003:8–41.
Ofori-Asenso R, Agyeman AA. Irrational use of medicines: a summary of key concepts. Pharmacy (Basel). 2016;4(4):1–13. DOI: https://doi.org/10.3390/pharmacy4040035
World Health Organization. How to investigate drug use in health facilities: selected drug use indicators. Geneva: WHO. 1993:3–48.
United Nations. World population ageing 2019: highlights. New York: United Nations. 2019:1–27.
Maher RL, Hanlon J, Hajjar ER. Clinical consequences of polypharmacy in elderly. Expert Opin Drug Saf. 2014;13(1):57–65. DOI: https://doi.org/10.1517/14740338.2013.827660
Mangoni AA, Jackson SH. Age-related changes in pharmacokinetics and pharmacodynamics: basic principles and practical applications. Br J Clin Pharmacol. 2004;57(1):6–14. DOI: https://doi.org/10.1046/j.1365-2125.2003.02007.x
Routledge PA, O’Mahony MS, Woodhouse KW. Adverse drug reactions in elderly patients. Br J Clin Pharmacol. 2004;57(2):121–6. DOI: https://doi.org/10.1046/j.1365-2125.2003.01875.x
Holloway KA. Combating inappropriate use of medicines. Expert Rev Clin Pharmacol. 2011;4(3):335–48. DOI: https://doi.org/10.1586/ecp.11.14
Chaturvedi VP, Mathur AG, Anand AC. Rational drug use: as common as common sense. Med J Armed Forces India. 2012;68(3):206–8. DOI: https://doi.org/10.1016/j.mjafi.2012.04.002
Ofori-Asenso R. A closer look at the World Health Organization's prescribing indicators. J Pharmacol Pharmacother. 2016;7(1):51–4. DOI: https://doi.org/10.4103/0976-500X.179352
Tiwari P, Sharma P. Drug utilization study in elderly patients in a tertiary care hospital in India. Int J Basic Clin Pharmacol. 2018;7(6):1097–02. DOI: https://doi.org/10.18203/2319-2003.ijbcp20180101
Chikatipalli R, Kuttiappan A, Kumar S, Vishali R, Kujur P, Afsal NA, et al. Prescribing trends and rational drug use patterns in cardiovascular patients: a cross-sectional observational study. Bioinformation. 2024;20(11):1582–7. DOI: https://doi.org/10.6026/9732063002001582
Tiwari H, Sharma M. Drug utilization study in cardiovascular diseases in a tertiary care hospital. Int J Basic Clin Pharmacol. 2014;3(3):486–91.
Prabhakaran D, Jeemon P, Roy A. Cardiovascular diseases in India: current epidemiology and future directions. Circulation. 2016;133(16):1605–20. DOI: https://doi.org/10.1161/CIRCULATIONAHA.114.008729
Corsonello A, Pedone C, Incalzi RA. Age-related pharmacokinetic and pharmacodynamic changes and risk of adverse drug reactions. Curr Med Chem. 2010;17(6):571–84. DOI: https://doi.org/10.2174/092986710790416326
Rodgers JL, Jones J, Bolleddu SI, Vanthenapalli S, Rodgers LE, Shah K, et al. Cardiovascular risks associated with gender and aging. J Cardiovasc Dev Dis. 2019;6(2):19. DOI: https://doi.org/10.3390/jcdd6020019
James PA, Oparil S, Carter BL, Cushman WC, Dennison-Himmelfarb C, Handler J, et al. 2014 evidence-based guideline for the management of high blood pressure in adults (JNC 8). JAMA. 2014;311(5):507–20. DOI: https://doi.org/10.1001/jama.2013.284427
Savarese G, Lund LH. Global public health burden of heart failure. Card Fail Rev. 2017;3(1):7–11. DOI: https://doi.org/10.15420/cfr.2016:25:2
Moscucci F, Baratta F, Bucciarelli V, Mattioli AV, Pinti M, Zanini G, et al. Inflammaging and cardiovascular risk in old women. High Blood Press Cardiovasc Prev. 2026;33(2):171–81. DOI: https://doi.org/10.1007/s40292-025-00758-1
Ngcobo NN. Influence of ageing on pharmacodynamics and pharmacokinetics of chronically administered medicines in geriatric patients: a review. Clin Pharmacokinet. 2025;64(3):335–67. DOI: https://doi.org/10.1007/s40262-025-01494-4
Ermakov D, Fomina E, Kartashova O. Specific features of rational pharmacotherapy in elderly patients. European J Hospital Pharm. 2021;5:718. DOI: https://doi.org/10.1136/ejhpharm-2021-002980
Smith SC, Benjamin EJ, Bonow RO, Braun LT, Creager MA, Franklin BA, et al. AHA/ACCF secondary prevention guideline update. J Am Coll Cardiol. 2011;58(23):2432–46. DOI: https://doi.org/10.1016/j.jacc.2011.10.824
Fihn SD, Blankenship JC, Alexander KP, Bittl JA, Byrne JG, Fletcher BJ, et al. 2014 ACC/AHA guideline update for stable ischemic heart disease. J Am Coll Cardiol. 2014;64(18):1929–49. DOI: https://doi.org/10.1016/j.jacc.2014.07.017
Hatami N, Malekpour MR, Farzadfar F, Seyedifar M, Soleymani F. Utilization patterns of cardiovascular medications in patients with diabetes mellitus: a retrospective cross-sectional study. DARU J Pharm Sci. 2023;31(2):259–66. DOI: https://doi.org/10.1007/s40199-023-00481-z
Kini V, Ho PM. Interventions to improve medication adherence. JAMA. 2018;320(23):2461–73. DOI: https://doi.org/10.1001/jama.2018.19271
Burnier M, Egan BM. Adherence in hypertension. Circ Res. 2019;124(7):1124–40. DOI: https://doi.org/10.1161/CIRCRESAHA.118.313220
Anagaw YK, Limenh LW, Geremew DT, Worku MC, Dessie MG, Tessema TA, et al. WHO prescribing indicators in community pharmacies. J Pharm Policy Pract. 2023;16(1):124. DOI: https://doi.org/10.1186/s40545-023-00607-3
Hailesilase GG, Welegebrial BG, Weres MG, Gebrewahd SA. WHO/INRUD prescribing indicators and antibiotic use. Antimicrob Resist Infect Control. 2024;13(1):133. DOI: https://doi.org/10.1186/s13756-024-01490-6