Trends in Management of Congestive Heart Failure patients in A Tertiary Care Hospital -A Retrospective Study

 

Sarumathy. S*, Madhumitha. V, Vishali. M, Janani. S, Englebert Rynjah. M, Priyadharshini. A

Department of Pharmacy Practice, SRM College of Pharmacy, SRM Institute of Science and Technology,

Kattankulathur, Tamil Nadu, India-603203.

 

ABSTRACT:

Background: Chronic heart failure is a common cardiovascular disease (CVD) which is a progressive disorder and results in a poor quality of life. Drug utilization studies is a strong explanatory tool to ascertain the usage of drugs in the population. It helps to maintain the rationality of prescription, to minimize the cost of therapy and adverse effects. Studies on prescribing trends in CHF patients are few; hence periodic assessment of drug use in CHF patients will help to promote the rational drug use. Aim: To analyze the current prescribing pattern in CHF patients.  Methodology: A retrospective observational study for 5 months was undertaken in General medicine and Cardiology department in a tertiary care teaching hospital. A total number of 135 congestive heart failure inpatients case sheets were collected and analyzed.  Results:  It was found that 62.33 % were males and 37.33% were females. The age group of about 65-69 years (36.29%) people was mostly affected by CHF. Hypertension (36.29%) and diabetes mellitus (17.78%) and both DM and HTN (19.26%) were the most commonly associated comorbidities in CHF patients. Cardiac glycosides are the most commonly prescribed drugs in nearly 90.37% of prescription. Followed by diuretics 88.88% and other anti hypertensives 80.7%. Among the anti hypertensives, CCBs 82.35% and ACE inhibitors 79.83% are most commonly prescribed. Conclusion: Cardiac glycosides, anti-anginal, anti-platelet and anti-hypertensives are most commonly prescribed in congestive heart failure patients. Most of the drugs were prescribed rationally according to the standard WHO treatment guidelines.

 

 

 

 

INTRODUCTION:

Cardio Vascular Disease is currently the leading cause of death, around 17.9 million people died from cardiovascular causes in 2016. In Western populations only 23% of CVD deaths occur before the age of 70 years; whereas 52% in India^[1] Disorders of the heart and the  blood vessels are the causes of  CVD which  includes hypertension, coronary heart diseases (CHD), congestive heart failure (CHF), stroke, peripheral artery disease and rheumatic heart disease.  Chronic heart failure is a common CVD, which is a progressive one that results in a poor quality of life.

 

 

 

Despite advances in the control of cardiovascular diseases such as myocardial infarction (MI), the incidence and prevalence of CHF is projected to rise.^[2] HF is said to be globally pandemic, since it affects around 26 million people worldwide^[3]. The annual incidence of HF for patients with CHD ranges from 0.4% to 2.3% per year^[4]. Heart failure (right or left) is the inability of the heart to maintain a balanced blood circulation in the body ^[5]. Around 80% of CHF cases occurs over the age of 65. Arrhythmias is present in about 10-50%) of patients with chronic heart failure and may represent either a cause or a consequence of heart failure. Other complications associated with CHF includes Stroke, thromboembolism, Hepatic congestion, hepatic dysfunction; pulmonary hypertension, Pulmonary congestion^[6].

 

 

 

Commonly used drugs to treat CHF are cardiac glycosides, diuretics, antianginal drugs, calcium channel blockers, beta blockers, diuretics, angiotensin converting enzyme inhibitors, angiotensin receptor blockers, antiplatelet and lipid-lowering agents. Irrational prescribing of drugs is common in clinical practice, due to lack of knowledge about the drugs, unethical promotions of drugs. Inappropriate prescribing leads to ineffective therapy, unsafe treatment, prolongation of illness and unnecessary economic burden to the patient^[7].

 

Drug utilization studies is a strong explanatory tool to ascertain the usage of drugs in the population. It helps to maintain the rationality of prescription, to minimize the cost of therapy and adverse effects.  Studies on prescribing trends in CHF patients are few, hence periodic assessment of drug use in CHF patients will helps to promote the rational use of drugs. Therefore, the present study attempts to analyze the current prescription pattern of hospitalized CHF patients in a tertiary care hospital.

 

METHODOLOGY:

A retrospective observational study for 5 months was undertaken in General medicine and Cardiology department in a tertiary care teaching hospital. A total number of 135 indoor congestive heart failure patient’s case sheets were collected in a structured proforma in accordance with the inclusion and exclusion criteria. The patient’s demographic details such as age, gender, social habits, diagnosis and co morbid disease conditions were collected. The prescribing trends includes average drugs/prescription, number of injections, number of generic drugs prescribed and commonly used drugs in CHF patients were analyzed and the results were expressed as counts and percentage.

 

RESULTS AND DISCUSSION:

A total of 135 patients case sheet were analyzed and the results indicated that (62.33%) male patients had a high frequency of Heart Failure compared to (37.77%) female patients which were in concordance with a study conducted by Cowie MR et al^[8]. The present study revealed that congestive heart failure was more prevalent in the age group of above 65-69 years which is similar to the study result by Jugdutt B et al ^[9], that patients over 65 age are more affected by heart failure. Around 19.24 % were smokers, 16.29 % were alcoholic and 13.33 % has the habit of both smoking and alcohol.

 

Table 1: Demographic Details of the Study Population

Category	No. of Patients (n = 135)	Percentage of Patients (%)
GENDER Male Female AGE WISE DISTRIBUTION  (IN YEARS) 0-9 10-19 20-29 30-39 40-49 50-59 60-69 70-79 80-89 SOCIAL HABITS Smoker Alcoholic Both smoker and alcoholic Non-consumers	84 51       3 1 1 6 28 22 49 22 3     26 22 18   69	62.33 37.77       2.22 0.74 0.74 4.44 20.74 16.29 36.29 16.29 2.22     19.24 16.29 13.33   51.11

 

Patients having comorbidities of ischemic etiology with hypertension are more likely to develop CHF. Hypertension (73%), coronary artery disease (57%) and diabetes (44%) were found to be the most common comorbid condition with CHF. Vincent M et al^[10] reported similar result to the present study. The details of the comorbidities in patients are given below in the Table 2.

 

Electrolyte abnormalities are a frequent and potentially hazardous complication in patients with heart failure. When treating congestive heart failures one must consider how to prevent depletion of electrolytes. Potassium deficiencies play an important role in the development of cardiac arrhythmias. In our study 95.55% of patients were monitored for the electrolyte levels. Schwinger RH and Erdmann et al^[11] suggested the same. Another study by  Cirstianavitale and Ilariaspoletini et al suggested that nearly 60% of the patients diagnosed with heart failure have coronary artery disease and in patients with acute coronary syndromes, myocardial ischemia is often a precipitant factor^[12] which is in accordance to our study, concluded that majority of the patients with CAD has occurrence of CHF.

 

Table 2: Co-Morbid Disease Conditions of the Study Population

Co-Morbid diseases	No. of Patients	Percentage
Diabetes mellitus Hypertension Diabetes mellitus and hypertension Renal disorder Hepatic disorder	24 49 26   21 15	17.78 36.29 19.26   15.55 11.12

 

In our study the average number of drugs per prescription was found to be 12.01 which is in concordance with the study conducted by Prasannakumar B et al ^[13]. It was found that 70.50% of drugs were prescribed in the brand name and 29.50% of drugs were prescribed in the generic name Number of drugs prescribed in brand name and generic name are given in Table 3.

 

Table 3: Number of Branded and Generic Drugs

	No. of Drugs (n=1634)	Percentage (%)
Branded Drugs Generic Drugs	1152 482	70.50 29.50

 

Table 4: Route of Drugs

Route	No. of Times Drugs Prescribed (n=1634)	Percentage (%)
Oral Injection	1239 395	75.82 24.17

 

TABLE 5: PRESCRIBING TRENDS IN CHF PATIENTS

Category of Drugs	No. of Prescription (n =135)	Percentage (%)
Cardiac glycosides Antianginal Antiplatelet drugs Antihypertensives Lipid lowering agents Anticoagulants Antiarrhythmic Bronchodilators Anxiolytics Diuretics Antidiabetic Laxatives	122 119 119 109 84 67 33 76 66 120 32 33	90.37 88 88 80.7 62.2 49.6 24.4 17.47 48.8 88.88 23.7 24.4

 

The prescribing pattern in CHF patients was analyzed. It was found that 90.37% patients were prescribed with cardiac glycosides followed by diuretics (88.88%) as like the study by Bharat Kumar D et al^[7]. Managing the hypertension is essential in CHF. Since Anti hypertensive drugs are one of the most commonly prescribed drugs in CHF, the prescribing pattern of Antihypertensive among the CHF patients are also evaluated. The percentage of case sheets that has ACE inhibitors were 79.83%, calcium channel blockers were 82.35%, beta blockers were 73.95% and ARBs were 19.33%.

 

Table 6: Prescribing Pattern of Anti-Hypertensives in Chf Patients

Antihypertensive drugs	No. of drugs	Percentage (%)
ACE inhibitors ARB Calcium channel blockers Beta blockers	95 23 98 88	79.83 19.33 82.35 73.95

 

Among the drugs prescribed in CHF, the prescribing pattern of anti hypertensive drugs is categorized. It was found that CCBs 82.35% and ACE inhibitors 79.83% are most commonly prescribed among all the anti hypertensives.

 

 

CONCLUSION:

The present study concluded that males are more affected by congestive heart failure than the females. Drugs prescribed in generic names are very less. It also found that many patients have co-morbidities like hypertension and diabetes, the risk factors like smoking and alcohol was also seen which were the main cause for congestive heart failure and their complications Cardiac glycosides, anti-anginal, anti-platelet and anti-hypertensives are most commonly prescribed in congestive heart failure patients. Most of the drugs were prescribed rationally according to the standard WHO treatment guidelines. There are very few prescription found to be irrational and it should be avoided for the better therapeutic outcomes.

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Accepted on 17.05.2019           © RJPT All right reserved

Research J. Pharm. and Tech 2019; 12(8): 3851-3853.