INTRODUCTION:

Cardiovascular diseases (CVDs) are a major cause of morbidity and mortality worldwide, with an estimated 17.9 million deaths in 2019. Management of CVDs often involves the use of cardiovascular drugs such as antiplatelet agents, lipid-lowering drugs, and antihypertensive agents. However, prescribing patterns of these drugs can vary among healthcare providers and can have an impact on patient outcomes.¹One of the major causes of death and morbidity throughout the world is cardiovascular disease (CVD). According to the reports of the World Health Organization (WHO), 17.9 million patients in 2021 died from CVDs (cardiovascular diseases) also it was reported that by 2027 approximately 20 million patients will die mainly due to heart disease.²

CVD is a serious concern globally and is considered one of the top ten global health problems by the World Health Organization (WHO) particularly in both industrialised and developing countries.³CVS is responsible for most of the deaths annually than any other disease since 1900.⁴ It has been reported that drug treatment is likely to be effective only when patients are informed well about the therapy.⁵ Recognition of the prescribing problems is one of the most fundamental steps towards improving the prescribing quality and medication safety. Both features required rational medication prescribing and inappropriate prescribing patterns should be identified and avoided.⁶ Rational use of drugs represents that patients receive drugs according to their clinical needs for an adequate time period and at the minimum cost. Misunderstanding over brand names, cost issues, unpredictable drug supply, non-existence of formulary in hospitals and lack of knowledge by patients regarding dosing schedules are the major causes of irrational use of drugs.⁷

Prescription writing is a science and an art, as it conveys the message from the prescriber to the patient.⁵ Rational drug prescribing is defined as “the use of the least number of drugs to obtain the best possible effect in the shortest period and at a reasonable cost.⁸

Prescribing patterns of cardiovascular drugs have been studied extensively in various healthcare settings worldwide.⁹ These studies have shown significant variations in prescribing practices, with differences in drug selection, dosing, and duration of treatment.¹⁰ Factors influencing prescribing patterns include patient characteristics, disease severity, comorbidities, drug interactions, cost, and availability of drugs. Therefore, it is important to assess the prescribing pattern of cardiovascular drugs in different healthcare settings to identify areas for improvement in clinical practice. This information can be used to develop evidence-based guidelines and educational interventions to promote rational and safe use of cardiovascular drugs. The present study aims to assess the prescribing pattern of cardiovascular drugs in a specific healthcare setting using a prospective observational design. The study will involve the collection of data on drug prescriptions and patient characteristics from medical records of patients receiving treatment for CVDs. The data collected will be analyzed to determine the frequency and appropriateness of cardiovascular drug prescriptions and identify factors influencing prescribing patterns. The findings of this study will provide valuable insights into the prescribing practices of cardiovascular drugs in the specific healthcare setting and inform the development of targeted interventions to improve the quality of care provided to patients with CVD.

MATERIALS AND METHODS:

Study site:

The study was conducted in Navodaya medical college hospital and research centre, Raichur Karnataka

Study duration:

The study duration was Three months after getting consent from the ethics committee.

Study method and size:

A prospective observational study was conducted with consecutive sampling, and 82 patients were included in the study.

Inclusion Criteria:

· Patients who are diagnosed with various cardiovascular conditions.

· Patients who are prescribed with at least one cardiovascular drug.

Exclusion Criteria:

· Incomplete data entry case records were excluded from the study.

Study Design:

Prospective observational research was conducted for three months. 82 pieces of data altogether were gathered. The institutional ethics committee approved the study's ethical conduct. A data collection form was designed to collect patient information. During the study period total 82 case records of the cardiovascular patients were studied.¹¹ Diagnosis along with the drugs prescribed was recorded for each patient of cardiovascular emergencies. From the medical records the following data was collected:

· Distribution of cardiovascular emergencies (age and sex wise).

· The most common cardiovascular emergencies treated.

· The outcome of each patient of cardiovascular emergencies.

· Average duration of stay in the hospital.

· The correlation of clinical outcome with treatment if possible.

· Average number of drugs prescribed per patient.

· Drug utilization trend in our hospital for cardiovascular emergencies.

Sampling and Selection Techniques:

The sample size was calculated by the biostatistician according to Confidence Interval 1.96 standard normal variate at 95%, the required sample size for the study was a minimum of 82 participants. This is depicted in Figure 1.

Analysis of data:

The overall information generated was entered in Microsoft excel sheet (2010 version) and results were expressed in the form of percentage.

RESULTS:

Table 1: Distribution of Common Cardiovascular Emergencies

Cardiovascular emergencies	Number of patients	Percentages (%)
Myocardial Infarction	30	36.58
Unstable angina	41	50
Congestive heart failure	8	9.76
Arrhythmias	3	3.66
Total	82	25(31.25)

Table 1 provides an overview of the distribution of common cardiovascular emergencies within the patient population. The data is presented in terms of the number of patients and the corresponding percentages. Myocardial Infarction is the most prevalent condition, accounting for 36.58% of cases, followed by Unstable Angina at 50%. Other conditions such as Congestive Heart Failure and Arrhythmias have comparatively lower representation, making up 9.76% and 3.66% of cases, respectively. In total, 82 patients were studied, and this table shows a summary of the percentage distribution of these cardiovascular emergencies within the study group.

Table 2: Number of Male and Female Patients

Cardiovascular emergencies	Male	Female
Myocardial Infarction	17(20.73%)	24(29.27%)
Unstable angina	9(10.98%)	21(25.60%)
Congestive heart failure	2(2.44%)	6(7.32%)
Arrhythmias	1(1.22%)	2(2.44%)
Total	29(35.37)	53(64.63%)

Table 2 breaks down the number of male and female patients for each cardiovascular emergency category. The data illustrates the gender distribution among patients. For Myocardial Infarction, 17 male patients (20.73%) and 24 female patients (29.27%) were observed. Similarly, Unstable Angina had 9 male patients (10.98%) and 21 female patients (25.60%), while Congestive Heart Failure saw 2 male patients (2.44%) and 6 female patients (7.32%). Arrhythmias exhibited a smaller number of cases, with 1 male patient (1.22%) and 2 female patients (2.44%). In total, there were 29 male patients (35.37%) and 53 female patients (64.63%), highlighting the gender distribution within each cardiovascular emergency category.

Table 3: Percentage of Patients Receiving Particular Drugs

S. No	Name of the drug	Percentage of the patients
1	Clopidogrel + Aspirin	80.49%
2	Aspirin (loading dose)	72%
3	Enoxaparin (SC)	70%
4	Atorvastatin	70%
5	Clopidogrel	65.68%
6	Metoprolol	68%
7	Nitro-glycerine	62%
8	Nicorandil	42.68%
9	Amlodipine	40%
10	Ramipril	32.93%
11	Furosemide	25.61%
12	Hydrochlorothiazide	16.6%
13	Dopamine	12.2%
14	Digoxin	9.76%
15	Torsemide	8.45%
16	Olmesartan	6.1%

Table 3 presents the percentage of patients who received specific drugs as part of their treatment. The data provides insights into drug utilization within the patient population. Among the drugs administered, Clopidogrel + Aspirin had the highest prescription rate at 80.49%, followed closely by Aspirin (loading dose) at 72%, Enoxaparin (SC) at 70%, and Atorvastatin at 70%. Other medications, such as Metoprolol, Nitro-glycerine, and Nicorandil, also played significant roles in treatment, with percentages ranging from 62% to 68%. This table offers an overview of the drug prescription patterns within the studied patient cohort.

Table 4: Condition of the patients at the time of discharge

Cardiovascular emergencies	Improved	Unchanged	Expired
Myocardial Infarction	27	2	3
Unstable angina	34	4	1
Congestive heart failure	3	0	2
Arrhythmias	4	2	0
Total	68	8	6
Percentage	83.9%	9.1%	7%

Table 4 outlines the outcomes of patients at the time of discharge from the healthcare facility. It classifies patients into three categories: "Improved," "Unchanged," and "Expired" for each cardiovascular emergency. Most patients with Myocardial Infarction and Unstable Angina improved, with percentages of 83.9% and 85%, respectively. A smaller percentage remained unchanged. Unfortunately, a portion of patients in all categories expired. This table provides a snapshot of patient outcomes upon leaving the healthcare setting.

Table 5: WHO Prescribing Indicators and Values

WHO prescribing indicators	Value
Average number of prescribed drugs per encounter	3.73 ± 1.1
% of drugs prescribed in generic name	40%
% of encounters with an antibiotic prescribed	12%
% of encounters with an injection prescribed	44%
% of drugs from EDL	75.89

Table 5 summarizes key World Health Organization (WHO) prescribing indicators and their corresponding values. It provides information about drug prescription practices in the study. Notably, the average number of prescribed drugs per encounter is 3.73±1.1, indicating the complexity of treatment regimens. The percentage of drugs prescribed in generic names is 40%, indicating adherence to generic drug prescribing. A significant portion of encounters involve antibiotic prescriptions (12%), and a substantial number involve injection prescriptions (44%). Furthermore, 75.89% of the prescribed drugs are from the Essential Drug List (EDL), demonstrating alignment with WHO recommendations. This table offers insights into prescription practices in the healthcare facility, with a focus on adherence to WHO guidelines.

DISCUSSION:

Myocardial Infarction and Unstable Angina were the most prevalent conditions, making up a significant portion of cases (36.58% and 50%, respectively). This distribution is consistent with many epidemiological studies that have shown Myocardial Infarction and Unstable Angina as leading cardiovascular emergencies. However, the exact percentages may vary based on the geographic region, the demographic characteristics of the population, and the specific time period of the study. Smith et al.⁹ found a similar trend, with Myocardial Infarction and Unstable Angina comprising 40% and 48% of cases, respectively, in a diverse urban population. This consistency suggests that these conditions remain prominent in various demographic settings.

Women comprised a substantial proportion of patients across all cardiovascular emergency categories. This is in line with the increasing recognition of the significance of cardiovascular diseases in women. Numerous studies have reported that cardiovascular diseases are a leading cause of morbidity and mortality among women, dispelling the misconception that these conditions primarily affect men. In a study by Johnson et al.¹², women represented a significant portion of patients with cardiovascular emergencies, challenging the historical notion that these conditions predominantly affect men.

The prescription rates of essential drugs like Clopidogrel + Aspirin, Aspirin (loading dose), and statins (Atorvastatin) are relatively high. High prescription rates of these medications are consistent with guidelines and recommendations for the treatment of cardiovascular emergencies. A study conducted by Brown and colleagues¹³ reported similar high prescription rates for these medications in a large-scale clinical trial. This consistency supports the notion that certain drugs are universally recognized and prescribed as standard in cardiovascular emergency management.

A majority of patients with Myocardial Infarction and Unstable Angina improved during their treatment, but there was a mortality rate. Similar studies may report varying rates of patient improvement and mortality. The variation could be influenced by factors like the quality of healthcare facilities, access to early intervention, and the implementation of evidence-based treatment protocols. Jones et al.¹⁴ documented comparable outcomes, emphasizing the challenge of achieving uniform improvement and the need for continuous efforts to enhance patient care in cardiovascular emergencies.

CONCLUSION:

In conclusion, a significant proportion of patients diagnosed with Myocardial Infarction and Unstable Angina experienced improvement through their respective treatments. However, the presence of a mortality rate underscores the complexity of managing cardiovascular emergencies. Notably, the variability in outcomes observed across similar studies suggests the influence of multiple factors, such as the quality of healthcare facilities, accessibility to early interventions, and adherence to evidence-based treatment protocols. Future research and interventions should focus on identifying and addressing the contributing factors to mortality, with the ultimate goal of refining and optimizing cardiovascular emergency care on a broader scale.

CONFLICT OF INTEREST:

There is no conflict of interest.

ACKNOWLEDGMENTS:

The authors would like to thank hospital staff members for their cooperation and support in the completion of the project.

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Received on 19.12.2023 Revised on 16.05.2024

Accepted on 03.08.2024 Published on 03.05.2025

Available online from May 05, 2025

Asian J. Pharm. Res. 2025; 15(2):109-113.

DOI: 10.52711/2231-5691.2025.00018

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