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Volume 5, Issue 4, April – 2020 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165
IJISRT20APR076 www.ijisrt.com 304
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
causes of mortality. Cardiovascular diseases are
diseases of heart and blood vessels which include
coronary arterial disease; rheumatic heart diseases,
congenital heart diseases, deep vein thrombosis and
pulmonary embolism. As prescription audit is one of the
systematic tools for determining the quality of medical
care which also provide the documented evidence to
support diagnosis and treatment. The risk factors for
cardiovascular diseases are smoking, harmful use of
alcohol, hypertension, diabetes etc. The aim was to
study the prescription pattern of cardiac drugs in
cardiac outpatients in Crimson Hospital. Patient’s
information was collected by observing the patients
medication record with cardiovascular disease
diagnosed by a cardiologist. Total 201 patients were
included who were clinically diagnosed with
cardiovascular diseases. The result of this study shows
that most of the cardiac patients were age group from
61-70 years (26.4%) followed by 51-60 year age group
(23.4%). Cardiovascular disease was more in male in
comparison to female. Brahmin patients (42%) were
mostly diagnosed with CVD in comparison to other
races It was found that alcohol consumers patient were
more in number than smokers and tobacco consumers.
In occupation wise distribution most of the CVD
patients were housewife (34.82%) followed by farmers
(21.89%). During our study, we found most of the
classified cardiac drugs were Renin-Angiotensin system.
Most of the prescribed cardiovascular drugs were anti-
platelet drug (7%) followed by calcium channel blocker
(amlodipine 6%) in cardiac patients. Hypertension
(47%) shows the highest diagnosis of diseases in
patients. Oral route was mostly preferred rather than
intravenous routes.
Keywords:- Cardiovascular drugs, Coronary artery
disease, Prescription, Prescription patter
I. INTRODUCTION
Non-Communicable Diseases (NCDs) are dominating
worldwide. About 2/3rd (66%) of death occur due to NCDs
(NHRC, 2019). In Nepal, NCDs began to be noticed in the
second half of the 20th century (Vaidya, 2011). Among
NCDs, Cardiovascular diseases (CVDs) are most
prevalence (Vaidya, 2011). CVD is regarded as a number
one killer in the world (Shakya et al., 2013). CVD is
regarded as burden in low and middle income countries like
Nepal (LMIC). In LMIC, 3/4th of world’s deaths are due to
CVD (WHO, 2017). CVD kills 17.7 million in 2015
worldwide or globally (Khanal et al., 2018).
In LMIC, people do not have the benefits of early
detection and treatment with risk factors compared to
people in high- income countries (WHO, 2017). CVD are a
group of disorder of the heart and blood vessels. It includes
coronary heart diseases, cerebrovascular diseases,
peripheral arterial diseases, rheumatic heart diseases,
congenital heart diseases, deep vein thrombosis and
pulmonary embolism (WHO, 2017)
Prevalence cardiac problem in Nepal are HTN,
Coronary artery diseases, Rheumatic heart diseases,
congenital heart diseases (Shakya et al., 2011). CVD is
burden in shealth problems in developing countries like
Nepal.Some of risk factors for CVDs are smoking, harmful
use of alcohol, physical inactivity, unhealthy diets, obesity,
hypertension, diabetes, hyperlipidemia (Dhungana et al.,
2018) CVD risk profile could be varied by age, sex, race
and occupation ( Dhungana et al., 2018). Raised Blood
pressure is the major risk factor for cardiovascular diseases.
Female were at higher risk of CVD as compared to males
(Bansal et al., 2016).
In order to reduce the CVD risk, field experts
recommend a stepwise robust approach i) Evaluate the way
people live, ii) Assess the main CVD risk factor, iii)
Sensitize the population and health care providers for this
problem (Adrega et al., 2018). Cardiovascular diseases
develop over a long time. CVD can be prevented or delayed
by effectively managing modifiable risk factors through
lifestyle changes, Pharmacologic therapy surgery.
Modifiable risk factors include overweight, obesity,
tobacco smoking, poor nutrition, insufficient physical
activities, and high blood cholesterol.
Cardiovascular medicines are key element in
preventing and treating cardiovascular diseases. Blood
Pressure lowering medicine and lipid lowering agent
reduces the chance of risk at patient developing
cardiovascular diseases. Cardiovascular medicines are used
to slow the progress of the diseases or treat symptoms in
patients who have the diseases.
Appropriate medication can improve the quality of life
and increased their life expectancy in patient with CVD.
Prescription audit is the systematic, critical analysis of the
quality of medical care, including the procedures used for
diagnosis and treatment, the use of resources, and the
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resulting outcome and quality of life for the patients and it
is a continuous cycle, involving observing practice, setting
standards, comparing practice with standards,
implementing changes and observing new practice (Nuthan
Kumar.et al., 2018). Prescription audit helps in assessing
the quality of medical care, as prescription provides
documented evidence to support diagnosis and treatment.
Prescription auditing has the capability to promote the
rational usages of drugs and essential medicine. It is
necessary to conduct prescription audit periodically to
make sure that the quality of health care provided. WHO
has recommended core prescribing indicators to investigate
the drug use in health facilities. These are average number
of drugs per encounter, percentage of drugs prescribed by
generic name, percentage of encounters with an antibiotic
prescribed, percentage of encounter with an injection
prescribed, percentage of drugs prescribed from essential
drug list. These indicators aim to measure the performance
of health care providers in several important areas
pertaining to appropriate or rational use of drugs (WHO,
1993).
Rational of the study
Nepal is low and middle income countries, battling
with communicable and non-communicable diseases
(Vaidya, 2011).The incidence of CVD was 40% among
NCD in Nepal (Khanal et al., 2017). CVD is the leading
cause of mortality globally (Khanal et al., 2018).In 2012,
death occurs due to CVD was 17.5 million. i.e. 31 % of
total death. It has been estimated that 23.3 million people
would die by 2030 only due to CVDs (Khanal et al., 2017).
In Nepal, CVD was first documented in 1970s with MI,
Coronary heart diseases (CHD) is most privileges among
CVDs. A study done in Dharan found that privilege of
C.H.D is 6% in male. In Gangalal National Heart Centre,
the number of patient doubled annually between 2001 and
2008. Among 20% of CVDs patient, 8% patient had CHD
in Tribhuvan University Teaching Hospital. The most
common diseases of CVD after CHD are (Vaidya, 2011).
RHD (20-28%)
Hypertensive heart diseases (7-9%)
Arrhythmia (4-11%)
Congenital heart diseases (4-7%)
Endocarditis (0.5-2.5%)
Ischemic Heart Diseases (IHD) are the leading cause
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
100,000. About 2.46 % of premature death caused by IHD.
Major risk factor contributing to death are high systolic
blood pressure i.e. 5.87 % and smoking i.e. 7.19 % (NHRC,
2019)
In 2017, I.H.D is the leading (first) cause of death i.e.
100.45 rate per 100,000. 11.34 % premature deaths caused
by IHD. Percentages of risk factor contributing to death are
high systolic B.P i.e. 13.52 and smoking i.e. 12.89 (NHRC,
2019)
It has been estimated that tobacco consumption in
adults will be double from 12% in 1995 to 25% in 2025 and
rise to a staggering 40% by 2025 (Vaidya, 2011).
Management of CVDs in Nepal has been focused on
treatment rather than education preventive health care.
II. OBJECTIVE
General objective
To study, the prescription audit of cardiac drugs in
cardiac outpatient in Crimson College of technology.
Specific Objective
To study the demographic of cardiac patients.
To study the diagnosis of patients prescribed with
cardiac drugs.
To study about pattern of prescribed cardiac drugs.
To study the prescribed cardiac drugs as per WHO core
indicators.
III. LITERATURE REVIEW
CVDs are diseases of heart and blood vessels. It
include coronary arterial diseases, rheumatic heart diseases,
congenital heart diseases, deep vein thrombosis and
pulmonary embolism (Nooreen et al., 2018). CVD
increases the burden of diseases across the globe (Nooreen
et al., 2018). Numbers of drugs have been used to minimize
cardiovascular events and mortality(Sharma et al, 2013).
They are anti-platelets, β-blockers, angiotensin converting
enzyme (ACE) inhibitors, angiotensin receptor blocker
(ARB) and cholesterol lowering statins. Second and third
generation pharmacological agents show more
pharmacological and clinical benefits (Sharma et al., 2013).
Example: atorvastatin and rosuvastatin have less toxicity
over older statin (Sharma et al., 2013). Prescription Audit
refers to studying the prescribing pattern in order to
monitor, evaluate and if necessary suggest modifications in
the prescribing practices of medical practioners (Saha et al.,
2018).
Prescription auditing has potential to promote the
rational usages of drugs and essential medicines. Essential
medicines are one of the vital tools needed to improve and
maintain health. Potential benefit of prescription audit are
(Kandula et al., 2017).
Identify and promote good practice and promote good
practices.
Improve professional practice and quality standard.
Supports learning and development of staff and
organization.
Identify and eliminate poor or deficient practice.
Identify and eliminate waste.
Promote working with multidisciplinary team.
Allocate resource to provide better patient care.
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Epidemiology
CVD is the number one killer in the world. It kills 30
million in 2007 (Mendis et al., 2007) According to WHO,
17.5 million death occurs due to CVD in 2012. Among
CVD, 7.4 million death occurs were due to CHD and about
6.7 million were due to stroke (Nooreen et al., 2018)
A study conducted in the United Arab Emirates
(UAE) reported 35% with HTN, 34% having dyslipidemia,
14.4% had a coronary artery diseases( CAD) and 29.5%
with Diabetic mellitus (Govender et al.,2019). CVD is
prevailed in developed and under developed countries.
About 75% of death have occurred in underdeveloped and
developing countries (Nooreen et al., 2018). 3/4th death
occurs in low and middle countries. In 2016, about 13.8%
of industrial workers of Nepal were diagnosed with CVD.
In Nepal, HTN was the most prevalent risk factor for CVD
range from 26% to 38.9 % (Khanal et al., 2018). Heart
diseases mortality in men occurs at young age whereas in
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,
Penman, Strachan and Hobson, 2018)
Electrocardiogram
Chest X-ray
Echocardiography
Electrophysiology
Cardiac catheterization
Radionuclide imaging
Computed tomography
Magnetic resonance imaging
Bio-chemical Makers
Symptom of CVD (Ralston, Penman, Strachan and
Hobson, 2018)
Chest pain on exertion
Severe prolonged chest pain
Syncope
Palpitation
Breathlessness
Treatment of CVD: Medication (Division of non-
communicable diseases ministry of health, Kenya, 2018
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Table 2
Class
Example
Usual
monotheapy
Maxiumu
daily dose
Possible side effect
Long lasting CCB
Amlodipine
5 mg OD
10 mg OD
Oedema
Fatigue
Headache
Palpitation
Felodipine
5 mg OD
10mg OD
Nifedipine
Retard tab: 10-20
mg daily BD
LA tab:30mg OD
Retard tab: 30
mg daily BD
LA tab:90mg
OD
Thiazide diuretic
Chlorothiazide
25mg OD
50mg OD
Hypokalaemia
Hyponatraemia
Hyperuric aemia
Hypocalciuria
Hyperglycemia
Rash
Dyslipidaemia
Hydrochlorothiazide
12.5 mg OD
25 mg OD
Thiazide like diuretic
Indapamide
2.5mg OD
5mg OD
ACE Inhibitor
Captopril
25-50 BD or TDS
50 mg TDS
Cough (ACEI)
Hyperkalaemia
Increased serum creatinine
Angioedema
Enalapril
5-20 mg daily in
1 or 2
divided doses
20 mg daily
in 1 or 2
divided doses
Lisinopril
10 mg OD
40 mg OD
Perindopril
4 mg OD or 5 mg
OD
8 mg OD or
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
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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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IV. METHODOLOGY
Study site: The study was conducted at crimson
hospital which is located in manigram and provides health
services to rupandehi and other surrounding district like
gulmi, palpa, kapilvastu, nawalparasi and other districts.
This hospital has got various clinical departments like
psychiatry department, cardiac department, and dental,
orthopedics, dermatological, general and many more other
department.
Study type: This is prospective observational study.
Duration of study: The study was conducted for six
months.
Population size:
Total 201 patients were enrolled in this study.
Patient selection
Inclusion Criteria: The inclusion criteria were:
Patients of age more than 18.
Both the sexes were included in this study.
Patient who attained the cardiac outpatient department
at crimson hospital
Exclusion criteria: The exclusion criteria were:
Patient who refused to undergo follow up regular visit.
Patient who were not interested to participate in this
study.
Materials: Patient profile form was design manually
by the researchers. The dully filled form contains patient
demography data like name, address, age, gender,
occupation, education, marital status, medication history,
medical history, diagnosis, dosage form, dosage and
duration.
Method: The method of entire study was carried out
in three phases as discussed below:
PHASE: I
Pilot and Literature review: A pilot study was
carried out within a period of 4 weeks in order to analyze
the feasibility and scope of the project then the study
proposal was designed and its necessities of the project was
submitted to department of pharmacy by considering those
feasibilities and scope using final protocol.
Procuring the consent from hospital authority: In
order to carry out the proposed project in the hospital, it
should be reviewed and approved from the hospital
authority by the Dean/Director to precede the study ahead
and same as to the respective department along with
physicians and health care professionals to utilize the
hospital resources over the study period
Literature Survey: An exhaustive literature survey
was carried out regarding “prescription audit of cardiac
drugs in cardiac outpatient: A prospective study.” The
source includes journals like International journal of
research in medical science, Nepalese heart journal,
Bulletin of the world health organizations, Biomed central,
Journal of clinical and experimental research, etc.
Patients Selection: All the outpatient with cardiac
diseases diagnosed by Cardiac Doctor in the Crimson
Hospital were included in the study, prescribed with the
drugs, patient above the 12 years of age of either sex were
included in the study. Designing of Data entry
form/Questionnaire a separate Data entry format for
incorporating Details was designed incorporating Patient
Profile Form which contains details such as name, age,
address, gender, past medication History, present
medication History, medications, dose/frequency etc.
PHASE- II
A plan was carried out to collect the record of patients
suffering from cardiac diseases arrived at the OPD of
Hospital within a period of three months. All the records
were collected including demographic information and
different drugs which were prescribed by the Doctors.
Altogether 201 patient’s record was randomly collected and
was analyzed. The drugs prescribed in Brand names by
qualified medical Doctors were then decoded into generic
names by using Latest version of DIMS.
Assessing the prescription: Prospective data from
patient medical cardex records with at least one drug along
with supportive medications were obtained with regard to
age, and prescribed. A total of 201 prescriptions were
collected, observed and recorded.
PHASE-III
Data Entry : The record of patient medications of the
cardiac diseases were collected from the outpatient
department from 25 july 2019- 25th to September 2019
paying attention to inclusion and exclusion criteria and
were prospectively evaluated for the presence and
fulfillment of following variables.
Patients details: name, age, sex, address, occupation,
marital status etc.
Date of collection
Diagnosis
Medical History
Medication History
Dosage form
Prescribed drugs
Dose, Frequency and Duration
All of the above information on the record were noted
and captured into the personal computer (ms-Excel).Data
were coded, checked for completeness and consistency.
Data Evaluation:
Patient Medical Record obtained during data
collection was evaluated in ms-excel. All the Information
collected regarding the Prescription audit of Cardiac Drugs
used in Cardiac Diseases in the medication record including
the study of demographic characteristic and diagnosis of
Patients prescribed with cardiac drugs, study about pattern
of prescribed cardiac drugs, essential drug prescribed, and
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study of prescribed cardiac drugs as per WHO core
indicators.
Report preparation:
Information Regarding the drug prescription pattern,
use of essential drugs, risks for patients adverse effect,
prescribing indicators given by WHO and other factors
related were incorporated in the report. For descriptive
statistics, results were expressed in terms of percentages
and presented using tables according to the types of tool
used.
Report Submission:
After completing the report entitled “Prescription
Audit of Cardiac Drugs in Cardiac Outpatient: A
Prospective Study” was submitted to the department of
pharmacy, Crimson College of Technology and to the
Crimson Hospital, Manigram, Rupandehi, Nepal hoping for
the proper implementation for expected outcomes to
contribute improving the quality of drugs prescription
pattern for patients and with the anticipation to appreciate
in the future.
V. RESULT
Age-wise distribution of patient
Altogether 201 patients were included in this study.
The age distribution of the patient is given in table. At
present study, most of CVD patient from age group 60-70
years (25.37%) followed by 50-60 year age group (22.39%)
. The mean average is 57.2 and standard deviation is ±14.4
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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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
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
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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).
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.
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
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VI. DISCUSSION
In our study, total 201 number of cardiac patient were
analyzed which contain 56% were male and 44% were
female, due to availability of more population of male in
the hospital locality. The similar type of study was done in
Karnataka (India) found that 64.7% male and 35.3% female
(Nagabushan et al., 2015). At present study, most of
cardiovascular disease patient from age group of 61-70
years (26.4%) followed by 51-60 year age group
(23.4%).The mean average age is 57.2 and standard
deviation is ±14.47. In our study, we Found that Brahmin
races were 41.71%, followed by Chhetri (12.06%). The
highest percentage of Brahmin patient found because the
study was conducted in the Brahmin locality which is in
accordance with the study conducted by the RR Dhugana
(Dhungana et al., 2015)
In our study, 62.45% patients had social history.
Among them 24.05% patients were addicted to alcohol,
37.55% patients were to smoking and 14.77% patients were
addicted to tobacco. The proportion of alcohol consumers
(24.05%) and smokers (23.62%) were higher than tobacco
consumer.
In case of occupation wise distribution of patients, the
highest number of patient was found to be
housewife(34.82%) followed by farmer(21.89%).The
percentage of housewife was highest due to lack of
exercise, poor education level, fatty food consumption,
obesity etc. In a similar study conducted in Kathmandu,
Nepal found that 45.2% were housewife followed by self-
employed(24.7%) and other (Dhungana et al., 2015)
According to the study we found that the more patient
were diagnosed with HTN (47.76%), followed by MI
(19.90%), IHD (12%). The similar study was conducted in
the Karachi, Pakistan found that ,more patient were
diagnosed with HTN followed by IHD (20%) and MI(10%)
(Ali H, 2015)
The incidence of CVD is higher in male than female.
It was found that the incidence of HTN in male (23.38%)
and female (24.38%) were similar, whereas MI was
diagnosed at higher rate in male (12.94%) than female
(6.97%). The incidence of IHD is almost double times in
male (7.96%) as compared to female (4.98%).
Mostly CVD patient may suffer from other diseases.
We had found that CVD patients suffered from diseases
like COPD (8.43%), DM (54.22%), Hypothyroidism
(7.23%), Anxiety (7.23%), Gastritis (6.02%) etc. Among
them DM patients (54.22%) were diagnosis as highest in
CVD patients.
Mostly two numbers of drugs were prescribed to 24 %
patients followed by three numbers of drugs, four number
of drugs, and five number of drugs. The average of drugs
prescribed per prescription is 4.9 whereas in other type of
similar studies showed 3.1,6.49 and 8.8 (Darji et al., 2015)
(Dabhade et al., 2013) (H. & S., 2011).
Drugs related to CVD are renin-angiotensin system,
lipid modifying agents, beta blocking drugs, anti-diuretics,
etc. Among the classification of cardiovascular prescription
medicine we found the rennin-angiotensin system agent
(19.71%), were more used in cardiac patient followed by
diuretics (18.10%) and antithrombotic (17.37%) then other
drugs.
Our prescription database includes 95 different drugs.
The prescription of CVD preventive drugs in the study was
frequent. The most commonly prescribed drugs were
losartan (10%) followed by aspirin (7%), amlodipine (7%),
clopidogrel (5%), metoprolol (5%), Rosuvastatin (5%) etc.
The most commonly prescribed drugs were
antihypertensive drugs followed by antiplatelet
androsuvastatin drugs.
WHO has recommended core prescribing indicators to
investigate the drug use in health facilities that helps to
measure the rational use of drugs. As per the prescription of
our study only 0.1% of drugs were prescribed in generic
names whereas the other studies showed that about 60%,
63.34% and 4.16% (H. & S., 2011) (Darji et al.,2015)
(Kaur B, Walia R, 2013). Among 992 drugs prescribed to
201 patients, the prescribers prescribed 420 drugs from the
national EDL. According to our prescription database,
prescribers prescribed 0.3% injection dosages form over
CVD patients.
VII. CONCLUSION
In conclusion, the result of this study shows that most
of the cardiovascular drugs are used in the treatment of
cardiac diseases in cardiac patients. During our study most
of the CVD patients were male. It is found that CVD occurs
between 60-70 age groups. Patient addicted to alcohol,
smoking and tobacco had high incidence to be affected by
CVD .We have found that, most of CVD patient were
housewife. In our study we found that most of the patients
were diagnosed with HTN followed by MI and IHD. HTN
diagnosis patient were similar in male and female but MI
diagnosed patient were more in male. We have found that
prescribers prescribed two numbers of drugs to large
number of patients. In our study we found that most of the
cardiovascular drugs groups are prescribed among which
anti- hypertensive significantly highest percentage of
prescription had. Among the cardiovascular drugs losartan
were given to large number of patient followed by
amlodipine, aspirin and so on.
The study showed that there will be still a high
number of branded drug prescribed for cardiovascular
patients. By minimizing the prescription of branded drugs,
patient’s quality care can be obtained and economic burden
can be reduce to the patients. By studying more no of cases
in different hospitals the result may be more accurate.
Volume 5, Issue 4, April – 2020 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165
IJISRT20APR076 www.ijisrt.com 317
LIMITATION
One of the limitations is sample size calculation and
sampling method. Sample size was not calculated prior to
study and also we follow the purposive sampling rather
than randomization. The major limitation is the follow up
the patients. Since the study was conducted only in one
hospital. By analyzing more no of cases in different
hospital the result may be more accurate.
REFERENCES
[1]. Adrega T, Ribeiro J, Santos L, Santos JA (2018),
Prevalence of cardiovascular disease risk factor,
health behaviours and arterial fibrillation in a
Nepalese post-seismic population : A cross-sectional
screening during a humanitarian medical mission,
Nepalese heart journal, 15(2), 9-13.
[2]. Calling S, Johansson SE, wolff M, Sundquist J,
Sundquist K,(2019), The ratio of total cholesterol to
high density lipoprotein cholesterol and myocardial
infarction in women’s health in the lund area: A 17
year follow up cohort study, BioMed
centralcardiovascular disorder,19(239), 1-9.
[3]. Dabhade S, Gaikwad P,(2013)<Comparative
evaluation of prescription of MBBS and BAMS
doctors using WHO prescribing indicators, Medical
journal of Dr. DY PatilUniversity,6(4), 411.
[4]. Darji NH, Vaniya H,(2015), Prescription audit in the
inpatients of a tertiary care hospital attached with
medical college, Journal of Clinical and
ExperimentalResearch, 3(2),197.
[5]. Dhungana RR, Khanal MK, Pandey AR, Thapa P,
Devkota S, Mumu SJ, Shayami A, Ali L (2015).
Assessment of short term cardiovascular risk among
40 years and above population in a selected
community of Kathmandu, Nepal. J Nepal Health
ResearchCouncil, 13(29), 66-72.
[6]. Dhungana RR, Thapa P, Devkota S, Banik PC, et
al,(2018), Prevalence of cardiovascular disease risk
factor: A community based cross-sectional study in a
peri-urban community of Kathmandu Nepal, Indian
heart journal,70, S22-S27.
[7]. Govender RD, Al-Shamsi S, soteriades ES, Regmi D,
(2019), Incidence and risk factor for recurrent
cardiovascular disease in middle eastern adults : A
retrospective study,BioMed central,19(253), 1-7.
[8]. H Nagabushan, HS Roopadevi, GM Prakash, R
Pankaja (2015). A prospective study of drug
utilization patterns in cardiac intensive care unit at a
tertiary care teaching hospital. International Journal of
Basis and Clinical Pharmacology, 4, 579-583.
[9]. http://www.health.go.ke/wp-
content/uploads/2018/06/Hand-book-Cardiovascular-
2018_19_5_18_Final.pdf
[10]. http;//apps.who.int>
[11]. https://mohp.gov.np/attachments/article/449/5.%20N
BoD%20Report%202019.pdf
[12]. https://www.aihw.gov.au/getmedia/e84e445a-b4f0-
4eac-96ee-b4cbf4e5639a/aihw-cvd-
80.pdf.aspx?inline=true
[13]. https://www.dwraju.com.np
[14]. https://www.who.int/medicines/publications/essential
medicines/en/
[15]. https://www.who.int/news-room/fact-
sheets/detail/cardiovascular-diseases-(cvds)
[16]. Kandula PK, Rao SB, Sangeeta K, Gudi SK et al,
(2017), A study of prescription audit in outpatient
department of a tertiary care teaching hospital in
India: an observational study, Journal of drug delivery
and therapeutics, 7(3), 92-97.
[17]. Khanal MK, Ahamad M, Moniruzzaman M, Banik
PC, et al, (2017), Total cardiovascular risk for next ten
years among rural population of Nepal using
WHO/ISH risk prediction chart, BioMed
central,10(120), 1-7.
[18]. Khanal MK, Ahamad M, Moniruzzaman M, Banik
PC, et al, (2018), Prevalence and clustering of
cardiovascular disease risk factors in rural population
aged 40-80 years, BioMed central,18(677), 1-13.
[19]. Kumar NUS, Nalini GK, Deepak P, Prema M,et
all,(2018),Prescription audit of outpatients in tertiary
care governmenthospital, International Journal of
Basic and Clinical Pharmacology, 7,636-639.
[20]. Mandis S, fukino K, Cameron A, Laing R, et al,
(2007), The availability and affordability of selected
essential medicine for chronic disease in six low and
middle income countries, Bulletin of the world health
organisation,85(4), 279-288.
[21]. Nooren M, Maryam, Hani H, Fatima S, et al, (2018),
A pharmacoepidemiology study of cardiovascular
drugs in intensive cardiac care unit patients in a
tertiary care hospital, International journal of medical
research and health science, 7(4), 88-93.
[22]. Olusesan FJ, Simeon OO, Olatunde OE, Oludare OI,
et al, (2017),Prescription audit in a paediatric sickle
cell in south west Nigeria :A cross sectional
retrospective study, Malawai medical journal, 29(4),
285-289.
[23]. Potharaju HR, Kabra SG,(2011),Prescription audit of
outpatient attendees of secondary level government
hospitals in Maharastha, Indian journal
ofPharmacology,43(2),150
[24]. Ralston SH, Penman ID, Strachan MWJ and Hobson
RP (2018) Davidson’s Principles and Practice of
Medicine (23rd edition) Elsevier ltd Edinburgh London
New York, 448-456.
[25]. Saha A, Bhattacharjya H, Sengupta B, Debbarma R,
(2018), Prescription audit in outpatient department in
teaching hospital of North East India, International
journal of research in medical science, 6(4), 1241-
1247.
[26]. Sakya S, Sharma D, Bhatta DY, (2011), Current
scenario of heart disease in Nepal: At a glance,
Nepalese heart journal, 8, 23-26.
[27]. Sharma KK, Mathur M, Gupta R, Guptha S,et
al,(2013), epidemiology of cardio-protective
pharmacological agent use in stable coronary heart
disease, Indian heartjournal, 65, 252-255.
Volume 5, Issue 4, April – 2020 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165
IJISRT20APR076 www.ijisrt.com 318
[28]. Solanki ND, Shah C, (2015), Prescription audit in
outpatient department of specialty hospital in western
India: an observational study, International journal of
clinical trials, 2(1), 14-19.
[29]. Vaidya A, (2011), tackling cardiovascular health and
disease in Nepal: epidemiology, strategies and
implementation, British medical journal, 87-91.
[30]. Zafar F, Ali H, Naveed S, Korai OU, Rizvi M, Naqvi
GR and Siddiqui S (2015). Drug utilization pattern in
cardiovascular Diseasess: A Descriptive Study in
Tertiary care settings in Pakistan. J Bioequiv Avilab,
7(1):026-029.
[31]. Bansal P, Chaudhary A, Wander P, Sajita M, Sarit
Sharma, Girdhar S ,et al (2016). Cardiovascular risk
assessment using WHO/ISH risk prediction charts in a
Rural area of North India, Journal of Research in
Medical and Dental Science, 4(2), 127-131.
[32]. Kaur B, Walia R (2013). Prescription audit for
evaluation of prescribing pattern of the doctors for
rational drug therapy in tertiary care hospital. Journal
of Drug Deliveryand therapeutics, 3(5), 77-80.
