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RESEARCH LETTER
Year : 2021  |  Volume : 12  |  Issue : 2  |  Page : 94-96
 

Risk factors and prescription pattern among patients with congestive heart failure


1 Department of Pharmacy Practice, NGSM Institute of Pharmaceutical Sciences, Nitte (Deemed to be University), Paneer, Mangaluru, Karnataka, India
2 Department of Cardiology, Justice K.S. Hegde Hospital, Deralakatte, Mangaluru, Karnataka, India

Date of Submission04-Mar-2021
Date of Decision29-Mar-2021
Date of Acceptance30-Apr-2021
Date of Web Publication17-Sep-2021

Correspondence Address:
Dr. Juno J Joel
Assistant Professor, Department of Pharmacy Practice, NGSM Institute of Pharmaceutical Sciences, Nitte (Deemed to be University), Deralakatte Mangaluru - 575 018
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jpp.jpp_25_21

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How to cite this article:
Jose J, Baby B, Ahammed S, Chand S, Nandakumar U P, Vinay B C, Subramanyam K, Joel JJ. Risk factors and prescription pattern among patients with congestive heart failure. J Pharmacol Pharmacother 2021;12:94-6

How to cite this URL:
Jose J, Baby B, Ahammed S, Chand S, Nandakumar U P, Vinay B C, Subramanyam K, Joel JJ. Risk factors and prescription pattern among patients with congestive heart failure. J Pharmacol Pharmacother [serial online] 2021 [cited 2021 Oct 18];12:94-6. Available from: http://www.jpharmacol.com/text.asp?2021/12/2/94/326178




Sir,

Congestive heart failure (CHF) is considered a condition that impairs the ventricle's ability to fill or eject blood due to a structural or functional disorder of the heart, having a prevalence rate of 0.3%–2%.[1],[2] Left-sided heart failure is most commonly caused by ischemic heart disease and hypertension (HTN), whereas right-sided heart failure is generally caused by the later stage of left-sided heart failure. These cardiac conditions may lead to mental complications, including stress and depression.[3] In India, there is less data regarding the exact prevalence and incidence of CHF.[4] Availability of these data may lead to the planning of safe and effective therapy. Drug utilization studies help in identifying the trends of the therapy for the disease.[5],[6] A prescription pattern study provides an insight into the treatment compliance with hospital formulary and other guidelines.[7] Deviation and irrationality in the standard therapy will help in amending the prescribing guidelines in the hospital.[8] The clinical pharmacist plays an essential role in assessing the risk factors and drug prescription patterns.[9] Hence, this study is carried out to identify the risk factors associated with CHF and pharmacotherapy in patients diagnosed with CHF.

A prospective observational study was conducted for 6 months among patients who were diagnosed with CHF. The institutional review board approved the study before collecting the data. Both hospitalized and outpatients of either gender, aged >18 years diagnosed with CHF, were considered eligible whereas, the patients without the data on the left ventricular ejection fraction were excluded from the study. A suitable data collection form was prepared and the relevant data were collected from the enrolled patients. Written patient informed consent was obtained prior to the data collection. Patient case sheets were carefully monitored on a daily basis during the ward rounds to assess the risk factors associated with CHF, comorbidities, and the details on the pharmacological treatment were collected. The collected information was analyzed using descriptive statistics. Analysis was carried out using Statistical Package for Social Sciences (SPSS version 16.0) for windows (IBM, Statistical Package for Social Sciences (SPSS version 16.0) for windows, Bangalore, India).

Out of a total of 150 patients, the majority were male (72.7%) and the remaining 41 were female (27.3%). There were 6.7% of patients found in the age group <45 years, 68% were found in the age group between 45 and 65 years, and 25.3% were found in the age group >65 years. The mean age of the study population was found to be 59.61 ± 9.42 years. Apart from the other associated risk factors of CHF, 28% of the study population was found to be suffering from comorbidities such as urinary tract infections, benign prostatic hyperplasia, aspiration pneumonia, and HTN. In the current study, it is found that coronary artery disease (CAD) was the highest risk factor for CHF (66.7%) followed by HTN (47.3%), diabetes mellitus (40%), etc., as summarized in [Table 1]. Among the study population, the percentage of drugs given for the treatment of CHF was nitrates (13.38%) followed by diuretics (12.03%) and beta blockers (7.66%). The adjunctive therapy given includes antiplatelets (25.26%), statins (14.73%), anticoagulants (4.5%), and antiarrhythmics (0.75%), followed by other classes of drugs as referenced in [Table 2]. In this study, it is observed that most of the patients (28.67%) are treated with a four-drug regimen followed by five drugs and six drugs regimen.
Table 1: Distribution of patients based on the pattern of risk factors

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Table 2: Distribution of congestive heart failure patient based on the prescription pattern

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The prevalence of CHF among male patients was higher than females showing that men are more susceptible to CHF than females. This aspect is assisted by the results of a study conducted by Gottdiener et al., stating that the incidence of CHF is greater in men than in women.[10] The patients of age group 45–65 years were found to be more susceptible to CHF. A study conducted by Baskota et al., showed a similar result stating that the prevalence of CHF was higher in the age group of 46–65 years, followed by the patients in the age group of >65 years.[11] The major risk factors for CHF in the current study population were CAD followed by HTN, diabetes mellitus, smoking, alcohol, and chronic obstructive pulmonary disease. Similar results were shown in a study conducted by Thanusubramanian et al.[12] This was because the study included older men than women and it was evident and well proved that CAD was the highest risk factor in men. Among the drugs prescribed for the treatment of CHF, it was found that nitrates were the most commonly used followed by diuretics, beta-blockers. The drugs given for supportive care in CHF include antiplatelets, statins, and anticoagulants. However, a study conducted by Faggiano et al., reported that the diuretics were the most frequently prescribed therapeutic agents to 83.5%, followed by angiotensin-converting enzyme inhibitors, digoxin, and nitrates.[13]

In this study, it is vividly clear that men are more susceptible to heart failure than women and the incidence of CHF increases with age. CAD, HTN, smoking, and diabetes were the highest identified risk factors for CHF. The most frequently used drugs in the management of heart failure are nitrates, diuretics, beta-blockers, angiotensin-converting enzyme inhibitors, followed by other classes of drugs. The identification of the risk factors and the proper management of the predisposing factors will have a great impact in reducing the complications of heart failure.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Mann DL, Chakinala M. Heart failure In: Kasper DL, Fauci AS, Hauser SL, Longo DL, Jameson JL, Loscalzo J, editors. Harrison's Principles of Internal Medicine. 19th ed. New York: McGraw-Hill Medical; 2015. p. 1500-1.  Back to cited text no. 1
    
2.
Hudson SA, McAnaw J, Dreischulte T. Chronic heart failure. In: Walker R, Whittlesea C, editors. Clinical Pharmacy and Therapeutics. 5th ed. New York: Elsevier; 2012. p. 333-50.  Back to cited text no. 2
    
3.
Varghese TP, Kumar AV, Varghese NM, Chand S. Depression related pathophysiologies relevant in heart disease: Insights into the mechanism based on pharmacological treatments. Curr Cardiol Rev 2020;16:125-31.  Back to cited text no. 3
    
4.
Reddy S, Bahl A, Talwar KK. Congestive heart failure in Indians: How do we improve diagnosis and management? Indian J Med Res 2010;132:549-60.  Back to cited text no. 4
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5.
Saldanha LV, John J, Javad AK, Shetty SM, Chand S, Joel JJ, et al. Usage pattern of gastroprotective agents among patient prescribed with NSAIDs in orthopedic department. Int J Cur Res Rev 2021;13:126-31.  Back to cited text no. 5
    
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Paul F, Babu N, Chand S, et al. Drug utilization evaluation and price variability study of non-steroidal anti-inflammatory drugs in the orthopaedic department of a tertiary care hospital. Plant Arch 2020;20 Suppl 02:1696-701.  Back to cited text no. 6
    
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Gouda V, Shastry CS, Mateti UV, Subrahmanya C, Chand S. Study on steroid utilization patterns in general medicine department. Res J Pharm Tech 2019;12:4777 81.  Back to cited text no. 7
    
8.
Al-Jabri MM, Shastry CS, Chand S. Assessment of drug utilization pattern in chronic kidney disease patients in a tertiary care hospital based on WHO core drug use indicators. J Glob Pharm Technol 2019;11:1-9.  Back to cited text no. 8
    
9.
Voora L, Sujit K, Bhandari R, Shastry CS, Chand S, Rawal KB. Doctor of pharmacy: Boon for healthcare system. Drug Invent Today 2020;14:153 8.  Back to cited text no. 9
    
10.
Gottdiener JS, Arnold AM, Aurigemma GP, Polak JF, Tracy RP, Kitzman DW, et al. Predictors of congestive heart failure in the elderly: The Cardiovascular Health Study. J Am Coll Cardiol 2000;35:1628-37.  Back to cited text no. 10
    
11.
Baskota M, Rao BS, Shakya R. Study on prescribing patterns of drugs used in heart failure. Kathmandu Univ J Sci Eng Technol 2006;2:1-10.  Back to cited text no. 11
    
12.
Thanusubramanian H, Kishore MK, Shetty R, Amberkar MB. A retrospective study of the treatment outcome of drug therapies used in heart failure patients with associated co-morbidities in a tertiary care hospital. J Clin Diagn Res 2016;10:C06-9.  Back to cited text no. 12
    
13.
Faggiano P, Opasich C, Tavazzi L, Achilli F, Gentile A, De Biase L, et al. Prescription patterns of diuretics in chronic heart failure: A contemporary background as a clue to their role in treatment. J Card Fail 2003;9:210-8.  Back to cited text no. 13
    



 
 
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