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Prescription Audit of Cardiac Drugs in Cardiac
Prescription Audit of Cardiac Drugs in Cardiac
ISSN No:-2456-2165
Abstract:- Cardiovascular disease is one of the largest CVD (WHO, 2017). CVD kills 17.7 million in 2015
causes of mortality. Cardiovascular diseases are worldwide or globally (Khanal et al., 2018).
diseases of heart and blood vessels which include
coronary arterial disease; rheumatic heart diseases, In LMIC, people do not have the benefits of early
congenital heart diseases, deep vein thrombosis and detection and treatment with risk factors compared to
pulmonary embolism. As prescription audit is one of the people in high- income countries (WHO, 2017). CVD are a
systematic tools for determining the quality of medical group of disorder of the heart and blood vessels. It includes
care which also provide the documented evidence to coronary heart diseases, cerebrovascular diseases,
support diagnosis and treatment. The risk factors for peripheral arterial diseases, rheumatic heart diseases,
cardiovascular diseases are smoking, harmful use of congenital heart diseases, deep vein thrombosis and
alcohol, hypertension, diabetes etc. The aim was to pulmonary embolism (WHO, 2017)
study the prescription pattern of cardiac drugs in
cardiac outpatients in Crimson Hospital. Patient’s Prevalence cardiac problem in Nepal are HTN,
information was collected by observing the patients Coronary artery diseases, Rheumatic heart diseases,
medication record with cardiovascular disease congenital heart diseases (Shakya et al., 2011). CVD is
diagnosed by a cardiologist. Total 201 patients were burden in shealth problems in developing countries like
included who were clinically diagnosed with Nepal.Some of risk factors for CVDs are smoking, harmful
cardiovascular diseases. The result of this study shows use of alcohol, physical inactivity, unhealthy diets, obesity,
that most of the cardiac patients were age group from hypertension, diabetes, hyperlipidemia (Dhungana et al.,
61-70 years (26.4%) followed by 51-60 year age group 2018) CVD risk profile could be varied by age, sex, race
(23.4%). Cardiovascular disease was more in male in and occupation ( Dhungana et al., 2018). Raised Blood
comparison to female. Brahmin patients (42%) were pressure is the major risk factor for cardiovascular diseases.
mostly diagnosed with CVD in comparison to other Female were at higher risk of CVD as compared to males
races It was found that alcohol consumers patient were (Bansal et al., 2016).
more in number than smokers and tobacco consumers.
In occupation wise distribution most of the CVD In order to reduce the CVD risk, field experts
patients were housewife (34.82%) followed by farmers recommend a stepwise robust approach i) Evaluate the way
(21.89%). During our study, we found most of the people live, ii) Assess the main CVD risk factor, iii)
classified cardiac drugs were Renin-Angiotensin system. Sensitize the population and health care providers for this
Most of the prescribed cardiovascular drugs were anti- problem (Adrega et al., 2018). Cardiovascular diseases
platelet drug (7%) followed by calcium channel blocker develop over a long time. CVD can be prevented or delayed
(amlodipine 6%) in cardiac patients. Hypertension by effectively managing modifiable risk factors through
(47%) shows the highest diagnosis of diseases in lifestyle changes, Pharmacologic therapy surgery.
patients. Oral route was mostly preferred rather than Modifiable risk factors include overweight, obesity,
intravenous routes. tobacco smoking, poor nutrition, insufficient physical
activities, and high blood cholesterol.
Keywords:- Cardiovascular drugs, Coronary artery
disease, Prescription, Prescription patter Cardiovascular medicines are key element in
preventing and treating cardiovascular diseases. Blood
I. INTRODUCTION Pressure lowering medicine and lipid lowering agent
reduces the chance of risk at patient developing
Non-Communicable Diseases (NCDs) are dominating cardiovascular diseases. Cardiovascular medicines are used
worldwide. About 2/3rd (66%) of death occur due to NCDs to slow the progress of the diseases or treat symptoms in
(NHRC, 2019). In Nepal, NCDs began to be noticed in the patients who have the diseases.
second half of the 20th century (Vaidya, 2011). Among
NCDs, Cardiovascular diseases (CVDs) are most Appropriate medication can improve the quality of life
prevalence (Vaidya, 2011). CVD is regarded as a number and increased their life expectancy in patient with CVD.
one killer in the world (Shakya et al., 2013). CVD is Prescription audit is the systematic, critical analysis of the
regarded as burden in low and middle income countries like quality of medical care, including the procedures used for
Nepal (LMIC). In LMIC, 3/4th of world’s deaths are due to diagnosis and treatment, the use of resources, and the
Etiology
Causation Pathway
Fig 1
Investigation of cardiovascular diseases (Ralston, Symptom of CVD (Ralston, Penman, Strachan and
Penman, Strachan and Hobson, 2018) Hobson, 2018)
Electrocardiogram Chest pain on exertion
Chest X-ray Severe prolonged chest pain
Echocardiography Syncope
Electrophysiology Palpitation
Cardiac catheterization Breathlessness
Radionuclide imaging
Computed tomography Treatment of CVD: Medication (Division of non-
Magnetic resonance imaging communicable diseases ministry of health, Kenya, 2018
Bio-chemical Makers
Lisinopril 10 mg OD 40 mg OD
Perindopril 4 mg OD or 5 mg 8 mg OD or
OD 10 mg OD
Ramipril 2.5 mg OD 10 mg OD
Beta blockers Atenolol 25 mg OD 100 mg
Bisoprolol 2.5 mg OD 20 mg OD
Carvedilol 6.25mg BD 25 mg
BD
Labetalol 100 mg BD 400 mg BD
Metoprolol succinate 25mg OD 100 mg OD
Nebivolol 5 mg OD 20 mg OD
ARB Candesartan 8 mg OD 32 mg OD
Table 2
Table 3
Threshold for treatment initiation (Division of non-communicable diseases ministry of health, Kenya, 2018)
Fig 2
Choice of medication for lowering B.P. (Division of non-communicable diseases ministry of health, Kenya, 2018)
Fig 3
Exclusion criteria: The exclusion criteria were: Assessing the prescription: Prospective data from
Patient who refused to undergo follow up regular visit. patient medical cardex records with at least one drug along
Patient who were not interested to participate in this with supportive medications were obtained with regard to
study. age, and prescribed. A total of 201 prescriptions were
collected, observed and recorded.
Materials: Patient profile form was design manually
by the researchers. The dully filled form contains patient PHASE-III
demography data like name, address, age, gender, Data Entry : The record of patient medications of the
occupation, education, marital status, medication history, cardiac diseases were collected from the outpatient
medical history, diagnosis, dosage form, dosage and department from 25 july 2019- 25th to September 2019
duration. paying attention to inclusion and exclusion criteria and
were prospectively evaluated for the presence and
Method: The method of entire study was carried out fulfillment of following variables.
in three phases as discussed below: Patients details: name, age, sex, address, occupation,
marital status etc.
PHASE: I Date of collection
Pilot and Literature review: A pilot study was Diagnosis
carried out within a period of 4 weeks in order to analyze Medical History
the feasibility and scope of the project then the study Medication History
proposal was designed and its necessities of the project was Dosage form
submitted to department of pharmacy by considering those Prescribed drugs
feasibilities and scope using final protocol. Dose, Frequency and Duration
Procuring the consent from hospital authority: In All of the above information on the record were noted
order to carry out the proposed project in the hospital, it and captured into the personal computer (ms-Excel).Data
should be reviewed and approved from the hospital were coded, checked for completeness and consistency.
authority by the Dean/Director to precede the study ahead
and same as to the respective department along with Data Evaluation:
physicians and health care professionals to utilize the Patient Medical Record obtained during data
hospital resources over the study period collection was evaluated in ms-excel. All the Information
collected regarding the Prescription audit of Cardiac Drugs
Literature Survey: An exhaustive literature survey used in Cardiac Diseases in the medication record including
was carried out regarding “prescription audit of cardiac the study of demographic characteristic and diagnosis of
drugs in cardiac outpatient: A prospective study.” The Patients prescribed with cardiac drugs, study about pattern
source includes journals like International journal of of prescribed cardiac drugs, essential drug prescribed, and
research in medical science, Nepalese heart journal,
Gender-wise distribution of patients. The Gender wise distribution of the patients is given in the fig 4 In our study, the
more number of CVD patient were male (56 %) and less number of patient were female (44%)
Social history wise distribution of patient: The social history wise distribution of patients is given in the figure 6 It was
found that alcohol consumer’s patients were more in numbers (24.05 %) as compared to smoking and tobacco consumer’s
patients.
Occupation wise distribution of patient: The occupation wise distribution of patients is given in the table 5 It was found
that most of the CVD patients were housewife (34.82%) compared to others.
Medical history wise distribution of patients: The medical history wise distribution of patients is given in figure 7
Medical history was evaluated and is presented in percentage. DM was found to be most prevalent among the patients.
Diagnosis in CVD Patients: The details of diagnosis of cardiovascular diseases are given in figure 8 Overall we found that,
Hypertension have highest majority (48.28 %) as associated diseases followed by MI (19.40 %).
Gender wise distribution of diseases: The gender wise distribution of disease are given in the figure 9 In our study, HTN is
more prevalence in female (24.38 %) than male (23.38 %), likewise for MI male (12.94%) suffered more than female (6.97%).
Number of Drug per Prescription in CVD Patients: Number of Drug per Prescription in CVD Patients are given in figure
10 the highest number of prescription contains two drugs i.e. 24%and least number of prescriptions contains seven and eight drugs
Most commonly prescribed drugs in CVD: The details of most commonly prescribed drugs in CVD patients are given in
figure 11 In our study, we found that losartan (10%), amlodipine (7%) and aspirin (7%) were most commonly prescribed drugs.
Classification of cardiac drugs (AIHW, 2017). The detail of classification of cardiac drugs are given in Table 6 In our
study, we found that drugs belonged to the class Renin-Angiotensin System agent were given to about 19.71% followed by
Antithrombotic agents (17.37%).
WHO recommended Prescribing indicator: The details of WHO recommended prescribing indicators are given below in
Table 7 (WHO, 1993).
According to the study we found that the more patient In conclusion, the result of this study shows that most
were diagnosed with HTN (47.76%), followed by MI of the cardiovascular drugs are used in the treatment of
(19.90%), IHD (12%). The similar study was conducted in cardiac diseases in cardiac patients. During our study most
the Karachi, Pakistan found that ,more patient were of the CVD patients were male. It is found that CVD occurs
diagnosed with HTN followed by IHD (20%) and MI(10%) between 60-70 age groups. Patient addicted to alcohol,
(Ali H, 2015) smoking and tobacco had high incidence to be affected by
CVD .We have found that, most of CVD patient were
The incidence of CVD is higher in male than female. housewife. In our study we found that most of the patients
It was found that the incidence of HTN in male (23.38%) were diagnosed with HTN followed by MI and IHD. HTN
and female (24.38%) were similar, whereas MI was diagnosis patient were similar in male and female but MI
diagnosed at higher rate in male (12.94%) than female diagnosed patient were more in male. We have found that
(6.97%). The incidence of IHD is almost double times in prescribers prescribed two numbers of drugs to large
male (7.96%) as compared to female (4.98%). number of patients. In our study we found that most of the
cardiovascular drugs groups are prescribed among which
Mostly CVD patient may suffer from other diseases. anti- hypertensive significantly highest percentage of
We had found that CVD patients suffered from diseases prescription had. Among the cardiovascular drugs losartan
like COPD (8.43%), DM (54.22%), Hypothyroidism were given to large number of patient followed by
(7.23%), Anxiety (7.23%), Gastritis (6.02%) etc. Among amlodipine, aspirin and so on.
them DM patients (54.22%) were diagnosis as highest in
CVD patients. The study showed that there will be still a high
number of branded drug prescribed for cardiovascular
Mostly two numbers of drugs were prescribed to 24 % patients. By minimizing the prescription of branded drugs,
patients followed by three numbers of drugs, four number patient’s quality care can be obtained and economic burden
of drugs, and five number of drugs. The average of drugs can be reduce to the patients. By studying more no of cases
prescribed per prescription is 4.9 whereas in other type of in different hospitals the result may be more accurate.