Volume 5, Issue 4, April – 2020 International Journal of Innovative Science and Research Technology

ISSN No:-2456-2165

Prescription Audit of Cardiac Drugs in Cardiac

Outpatient: A Prospective Study
Dr. Gautam Prasad Chaudhary, Mukesh Kumar Chaudhary, Dr.Mohammed Mustafa, Manisha Adhikari, Pankaj Kumar Sah,
Suruchi Devkota, Umesh Kumar Yadav
Department of Pharmacy
Crimson College of Technology-Under Pokhara University, Nepal

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

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resulting outcome and quality of life for the patients and it It has been estimated that tobacco consumption in
is a continuous cycle, involving observing practice, setting adults will be double from 12% in 1995 to 25% in 2025 and
standards, comparing practice with standards, rise to a staggering 40% by 2025 (Vaidya, 2011).
implementing changes and observing new practice (Nuthan
Kumar.et al., 2018). Prescription audit helps in assessing Management of CVDs in Nepal has been focused on
the quality of medical care, as prescription provides treatment rather than education preventive health care.
documented evidence to support diagnosis and treatment.
Prescription auditing has the capability to promote the II. OBJECTIVE
rational usages of drugs and essential medicine. It is
necessary to conduct prescription audit periodically to  General objective
make sure that the quality of health care provided. WHO To study, the prescription audit of cardiac drugs in
has recommended core prescribing indicators to investigate cardiac outpatient in Crimson College of technology.
the drug use in health facilities. These are average number
of drugs per encounter, percentage of drugs prescribed by  Specific Objective
generic name, percentage of encounters with an antibiotic  To study the demographic of cardiac patients.
prescribed, percentage of encounter with an injection  To study the diagnosis of patients prescribed with
prescribed, percentage of drugs prescribed from essential cardiac drugs.
drug list. These indicators aim to measure the performance  To study about pattern of prescribed cardiac drugs.
of health care providers in several important areas  To study the prescribed cardiac drugs as per WHO core
pertaining to appropriate or rational use of drugs (WHO, indicators.
1993).
III. LITERATURE REVIEW
 Rational of the study
Nepal is low and middle income countries, battling CVDs are diseases of heart and blood vessels. It
with communicable and non-communicable diseases include coronary arterial diseases, rheumatic heart diseases,
(Vaidya, 2011).The incidence of CVD was 40% among congenital heart diseases, deep vein thrombosis and
NCD in Nepal (Khanal et al., 2017). CVD is the leading pulmonary embolism (Nooreen et al., 2018). CVD
cause of mortality globally (Khanal et al., 2018).In 2012, increases the burden of diseases across the globe (Nooreen
death occurs due to CVD was 17.5 million. i.e. 31 % of et al., 2018). Numbers of drugs have been used to minimize
total death. It has been estimated that 23.3 million people cardiovascular events and mortality(Sharma et al, 2013).
would die by 2030 only due to CVDs (Khanal et al., 2017). They are anti-platelets, β-blockers, angiotensin converting
In Nepal, CVD was first documented in 1970s with MI, enzyme (ACE) inhibitors, angiotensin receptor blocker
Coronary heart diseases (CHD) is most privileges among (ARB) and cholesterol lowering statins. Second and third
CVDs. A study done in Dharan found that privilege of generation pharmacological agents show more
C.H.D is 6% in male. In Gangalal National Heart Centre, pharmacological and clinical benefits (Sharma et al., 2013).
the number of patient doubled annually between 2001 and Example: atorvastatin and rosuvastatin have less toxicity
2008. Among 20% of CVDs patient, 8% patient had CHD over older statin (Sharma et al., 2013). Prescription Audit
in Tribhuvan University Teaching Hospital. The most refers to studying the prescribing pattern in order to
common diseases of CVD after CHD are (Vaidya, 2011). monitor, evaluate and if necessary suggest modifications in
the prescribing practices of medical practioners (Saha et al.,
 RHD (20-28%) 2018).
 Hypertensive heart diseases (7-9%)
 Arrhythmia (4-11%) Prescription auditing has potential to promote the
 Congenital heart diseases (4-7%) rational usages of drugs and essential medicines. Essential
 Endocarditis (0.5-2.5%) medicines are one of the vital tools needed to improve and
maintain health. Potential benefit of prescription audit are
Ischemic Heart Diseases (IHD) are the leading cause (Kandula et al., 2017).
of death for last 16 years from 2002-2017 (NHRC, 2019).
In 1990, IHD were 3rd cause of death i.e. 67.72 rates per  Identify and promote good practice and promote good
100,000. About 2.46 % of premature death caused by IHD. practices.
Major risk factor contributing to death are high systolic  Improve professional practice and quality standard.
blood pressure i.e. 5.87 % and smoking i.e. 7.19 % (NHRC,  Supports learning and development of staff and
2019) organization.
 Identify and eliminate poor or deficient practice.
In 2017, I.H.D is the leading (first) cause of death i.e.  Identify and eliminate waste.
100.45 rate per 100,000. 11.34 % premature deaths caused  Promote working with multidisciplinary team.
by IHD. Percentages of risk factor contributing to death are  Allocate resource to provide better patient care.
high systolic B.P i.e. 13.52 and smoking i.e. 12.89 (NHRC,
2019)

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 Epidemiology with Diabetic mellitus (Govender et al.,2019). CVD is
CVD is the number one killer in the world. It kills 30 prevailed in developed and under developed countries.
million in 2007 (Mendis et al., 2007) According to WHO, About 75% of death have occurred in underdeveloped and
17.5 million death occurs due to CVD in 2012. Among developing countries (Nooreen et al., 2018). 3/4th death
CVD, 7.4 million death occurs were due to CHD and about occurs in low and middle countries. In 2016, about 13.8%
6.7 million were due to stroke (Nooreen et al., 2018) of industrial workers of Nepal were diagnosed with CVD.
In Nepal, HTN was the most prevalent risk factor for CVD
A study conducted in the United Arab Emirates range from 26% to 38.9 % (Khanal et al., 2018). Heart
(UAE) reported 35% with HTN, 34% having dyslipidemia, diseases mortality in men occurs at young age whereas in
14.4% had a coronary artery diseases( CAD) and 29.5% women occurs around 60 years of age (Calling et al., 2019)

 Etiology

Modifiable risk factors Non-Modifiable risk factors

Tobacco use & exposure to tobacco smoke Sex
Unhealthy diet Age
Overweight/obesity Race
Physical inactivity Family history
Harmful use of alcohol
Diabetes & hyperlipidaemia
Table 1

 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

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Class Example Usual Maxiumu Possible side effect
monotheapy daily dose
Long lasting CCB Amlodipine 5 mg OD 10 mg OD Oedema
Felodipine 5 mg OD 10mg OD Fatigue
Nifedipine Retard tab: 10-20 Retard tab: 30 Headache
mg daily BD mg daily BD Palpitation
LA tab:30mg OD LA tab:90mg
OD
Thiazide diuretic Chlorothiazide 25mg OD 50mg OD Hypokalaemia
Hydrochlorothiazide 12.5 mg OD 25 mg OD Hyponatraemia
Hyperuric aemia
Thiazide like diuretic Indapamide 2.5mg OD 5mg OD Hypocalciuria
Hyperglycemia
Rash
Dyslipidaemia
ACE Inhibitor Captopril 25-50 BD or TDS 50 mg TDS Cough (ACEI)
Enalapril 5-20 mg daily in 20 mg daily Hyperkalaemia
1 or 2 in 1 or 2 Increased serum creatinine
divided doses divided doses Angioedema

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

Irbesartan 150 mg OD 300 mg OD

Losartan 50 mg OD 100 mg OD
Telmisartan 40 mg OD 80 mg OD
Valsartan 80 mg OD 160 mg OD
CCB: Calcium channel blocker; ACE: angiotensin converting enzyme; ARB: angiotensin receptor blocker; OD: administer once
daily; BD: administer twice daily; TDS: administer 3 times daily

Table 2

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Table 3

 Surgical Operation (WHO, 2017)

 Coronary artery by pass
 Balloon angioplasty
 Valve repair and replacement
 Heart transplantation
 Artificial heart operation

Threshold for treatment initiation (Division of non-communicable diseases ministry of health, Kenya, 2018)

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Fig 2

Choice of medication for lowering B.P. (Division of non-communicable diseases ministry of health, Kenya, 2018)

Fig 3

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IV. METHODOLOGY Bulletin of the world health organizations, Biomed central,
Journal of clinical and experimental research, etc.
Study site: The study was conducted at crimson
hospital which is located in manigram and provides health Patients Selection: All the outpatient with cardiac
services to rupandehi and other surrounding district like diseases diagnosed by Cardiac Doctor in the Crimson
gulmi, palpa, kapilvastu, nawalparasi and other districts. Hospital were included in the study, prescribed with the
This hospital has got various clinical departments like drugs, patient above the 12 years of age of either sex were
psychiatry department, cardiac department, and dental, included in the study. Designing of Data entry
orthopedics, dermatological, general and many more other form/Questionnaire a separate Data entry format for
department. incorporating Details was designed incorporating Patient
Profile Form which contains details such as name, age,
Study type: This is prospective observational study. address, gender, past medication History, present
Duration of study: The study was conducted for six medication History, medications, dose/frequency etc.
months.
Population size:  PHASE- II
Total 201 patients were enrolled in this study. A plan was carried out to collect the record of patients
suffering from cardiac diseases arrived at the OPD of
 Patient selection Hospital within a period of three months. All the records
were collected including demographic information and
 Inclusion Criteria: The inclusion criteria were: different drugs which were prescribed by the Doctors.
 Patients of age more than 18. Altogether 201 patient’s record was randomly collected and
 Both the sexes were included in this study. was analyzed. The drugs prescribed in Brand names by
 Patient who attained the cardiac outpatient department qualified medical Doctors were then decoded into generic
at crimson hospital names by using Latest version of DIMS.

 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,

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study of prescribed cardiac drugs as per WHO core pharmacy, Crimson College of Technology and to the
indicators. Crimson Hospital, Manigram, Rupandehi, Nepal hoping for
the proper implementation for expected outcomes to
 Report preparation: contribute improving the quality of drugs prescription
Information Regarding the drug prescription pattern, pattern for patients and with the anticipation to appreciate
use of essential drugs, risks for patients adverse effect, in the future.
prescribing indicators given by WHO and other factors
related were incorporated in the report. For descriptive V. RESULT
statistics, results were expressed in terms of percentages
and presented using tables according to the types of tool  Age-wise distribution of patient
used. Altogether 201 patients were included in this study.
The age distribution of the patient is given in table. At
 Report Submission: present study, most of CVD patient from age group 60-70
After completing the report entitled “Prescription years (25.37%) followed by 50-60 year age group (22.39%)
Audit of Cardiac Drugs in Cardiac Outpatient: A . The mean average is 57.2 and standard deviation is ±14.4
Prospective Study” was submitted to the department of

Age group Number of patients (N) Percentage (%)

Less than 30 8 4.0
31-40 26 12.9
41-50 30 14.9
51-60 47 23.4
61-70 53 26.4
71-80 33 16.4
81-90 4 2.0
Total 201 100.0
Table 4:- Age distribution of the patients (n=201)

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%)

Fig 4:- Gender-wise distribution

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 Racial distribution of patients
The detail of racial distribution study patients are given in the figure 5 In our study we found that 41% were Brahmin
followed by chettri (12%), followed by others (27%).

Fig 5:- Racial wise distribution

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.

Fig 6:- social history wise distribution

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.

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Occupation No. of patient (N) Percentage (%)
House wife 70 34.82
Farmer 44 21.89
Service 37 18.4
Business 28 13.93
Others 22 10.94
Total 201 100
Table 5:- occupation wise distribution of patients

Fig 7:- Medical history wise distribution of 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%).

Fig 8:- Diagnoses in CVD

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Fig 9:- Gender wise distributions of diseases

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.

Fig 10:- Number of Drug per Prescription in CVD Patients

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Fig 11:- Most commonly prescribed drugs used in CVD

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).

ATC code ATC Classification Number (N) Percentage (%)

B01 Antithrombotic agent 119 17.37
C01 Cardiac Therapy 15 2.19
C02 Antihypertensive 14 2.04
C03 Diuretics 124 18.10
C04 Peripheral Vasodilators 2 0.29
C05 Vasoprotectives 0 0.00
C07 Beta Blocking Agents 107 15.62
C08 Calcium Channel Blockers 70 10.22
C09 Renin-Angiotensin system Agents 135 19.71
C10 Lipid modifying Agents 99 14.45
Total 685 100
Table 6:- Classification of cardiac drugs.

S.N WHO recommended prescribing indicators Result

1 Total number of drug prescribed 992
2 Average number of drug prescribed 4.905
3 Percentage of drugs prescribed by generic name 0.1
4 Percentage of patient encounters with an antibiotics prescribed 0.2
5 Percentage of patient encounters with an injection prescribed 0.3
6 Percentage of drugs prescribed from national EDL 42.33
Table 7:- WHO recommended prescribing indicators.

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VI. DISCUSSION similar studies showed 3.1,6.49 and 8.8 (Darji et al., 2015)
(Dabhade et al., 2013) (H. & S., 2011).
In our study, total 201 number of cardiac patient were
analyzed which contain 56% were male and 44% were Drugs related to CVD are renin-angiotensin system,
female, due to availability of more population of male in lipid modifying agents, beta blocking drugs, anti-diuretics,
the hospital locality. The similar type of study was done in etc. Among the classification of cardiovascular prescription
Karnataka (India) found that 64.7% male and 35.3% female medicine we found the rennin-angiotensin system agent
(Nagabushan et al., 2015). At present study, most of (19.71%), were more used in cardiac patient followed by
cardiovascular disease patient from age group of 61-70 diuretics (18.10%) and antithrombotic (17.37%) then other
years (26.4%) followed by 51-60 year age group drugs.
(23.4%).The mean average age is 57.2 and standard
deviation is ±14.47. In our study, we Found that Brahmin Our prescription database includes 95 different drugs.
races were 41.71%, followed by Chhetri (12.06%). The The prescription of CVD preventive drugs in the study was
highest percentage of Brahmin patient found because the frequent. The most commonly prescribed drugs were
study was conducted in the Brahmin locality which is in losartan (10%) followed by aspirin (7%), amlodipine (7%),
accordance with the study conducted by the RR Dhugana clopidogrel (5%), metoprolol (5%), Rosuvastatin (5%) etc.
(Dhungana et al., 2015) The most commonly prescribed drugs were
antihypertensive drugs followed by antiplatelet
In our study, 62.45% patients had social history. androsuvastatin drugs.
Among them 24.05% patients were addicted to alcohol,
37.55% patients were to smoking and 14.77% patients were WHO has recommended core prescribing indicators to
addicted to tobacco. The proportion of alcohol consumers investigate the drug use in health facilities that helps to
(24.05%) and smokers (23.62%) were higher than tobacco measure the rational use of drugs. As per the prescription of
consumer. our study only 0.1% of drugs were prescribed in generic
names whereas the other studies showed that about 60%,
In case of occupation wise distribution of patients, the 63.34% and 4.16% (H. & S., 2011) (Darji et al.,2015)
highest number of patient was found to be (Kaur B, Walia R, 2013). Among 992 drugs prescribed to
housewife(34.82%) followed by farmer(21.89%).The 201 patients, the prescribers prescribed 420 drugs from the
percentage of housewife was highest due to lack of national EDL. According to our prescription database,
exercise, poor education level, fatty food consumption, prescribers prescribed 0.3% injection dosages form over
obesity etc. In a similar study conducted in Kathmandu, CVD patients.
Nepal found that 45.2% were housewife followed by self-
employed(24.7%) and other (Dhungana et al., 2015) VII. CONCLUSION

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.

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LIMITATION [13]. https://www.dwraju.com.np
[14]. https://www.who.int/medicines/publications/essential
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