a b s t r a c tBackground: A wide variation exists in the patterns of pharmacotherapy among patients admitted with cardiovascular diseases. Very few studies have evaluated the potential determinants of drug utilization. Our objective was to evaluate the clinical characteristics and patterns of cardiovascular drug utilization among patients in coronary care unit (CCU) and assess the determinants of cardiovascular drug use among patients with coronary artery disease (CAD). Methods: In this retrospective cohort study, the medical records of CCU patients were reviewed independently by two trained physicians over one year. Patients were analyzed as two groups e those with CAD and without CAD. Multivariate logistic regression was done to identify the determinants of cardiovascular drug utilization in the CAD group. Results: Of 574 patients, 65% were males, 57% were <60 years. The five commonly prescribed drug classes were platelet inhibitors (88.7%), statins (76.3%), ACE-inhibitors/Angiotensin receptor blockers (72%), beta-blockers (58%) and heparin (57%). Poly-pharmacy (>5 drugs) was noticed in 71% of patients. A majority of patients had diagnosis of CAD (72.6%). CAD patients received significantly higher median number of drugs and had longer duration of CCU stay (p < 0.0001). Renal dysfunction for ACE-inhibitors [0.18 (0.09e0.36)], ST-elevation myocardial infarction for calcium channel blockers [0.29 (0.09e0.93)] and brady-arrhythmias for beta-blockers [0.3 (0.2e0.7)] were identified as determinants of decreased drug use in CAD group. Conclusion: Predominance of male gender, age <60 and poly-pharmacy was observed in CCU. Antithrombotics, statins, ACE-inhibitors/Angiotensin receptor blockers and beta-blockers were the most frequently prescribed drugs. Clinical co-morbidities (renal dysfunction, arrhythmias) decreased the utilization of ACE-inhibitors, beta-blockers among CAD patients.
INTRODUCTIONThis study aimed to examine age-and gender-related differences in the comorbidities, drug utilisation and adverse drug reaction (ADR) patterns of patients admitted to a coronary care unit (CCU).
MeThODsThe present study was a retrospective cohort study. Two trained physicians independently reviewed the case records of CCU patients over a period of one year (Jan-Dec 2008). The demographic, clinical, and drug prescription data of the patients were analysed according to age group (18-59 years vs ≥ 60 years) and gender.ResUlTs A total of 574 patients were admitted to the CCU during the study period. Of these 574 patients, 65.2%were male, and 48.4% were ≥ 60 years old. No significant gender-based differences were found for the prescription of cardiovascular and non-cardiovascular drugs, and ADR patterns (p > 0.05). Male patients aged ≥ 60 years were found to have a higher rate of polypharmacy than those aged 18-59 years (p = 0.001). The duration of hospital stay was longer in male than female patients (p = 0.008), and the duration of CCU stay was longer for male patients aged ≥ 60 years than males aged 18-59 years (p = 0.013). Compared to patients aged 18-59 years, a greater number of patients aged ≥ 60 years were prescribed cardiovascular (p = 0.006) and non-cardiovascular drugs (p = 0.015). Patients aged ≥ 60 years also had a higher rate of polypharmacy (p = 0.001) and ADRs (p = 0.013), and a longer duration of CCU stay (p = 0.013). Renal (p = 0.047) and cutaneous (p = 0.003) ADRs were found to be more common in patients aged ≥ 60 years.
CONClUsIONNo major gender-related differences were observed in the prescription, drug utilisation and ADR patterns of our study cohort. Higher drug utilisation, ADR rates, and longer duration of CCU stay were noted in patients aged ≥ 60 years.
Background: Several studies have shown lack of sufficient knowledge and awareness among doctors on ADR reporting. Knowledge and attitude of doctors about ADR greatly influences extent of reporting. Identifying factors affecting ADR-reporting is vital to enable Pharmacovigilance teams to implement interventions to enhance rate and quality of reporting of ADRs. Hence, this study is done to evaluate perceptions of doctors towards ADR-reporting and to determine barriers for reporting ADR.Methods: Cross sectional study conducted among doctors using a validated questionnaire to assess knowledge, attitude, practice and barriers for reporting ADRs. The questionnaire captured the demographic details, knowledge (14), attitudes (7) and practice pattern (4) towards pharmacovigilance. Descriptive statistics was used to assess the response among doctors.Results: Of 157 doctors who responded to questionnaire, 90% of doctors were aware of pharmacovigilance program mainly through PVG activities by AMC and pharmacology classes. Only 47% doctors reported ADRs. The composite score on knowledge of ADR reporting and on knowledge of ADR burden was found to be moderate. 90% doctors opined ADR monitoring in hospital should be mandatory. 83% doctors opined ADR reporting by one person can make significant difference to community. One-third doctors felt there should be financial reward for ADR-reporting. In suspected cases, 57% doctors include ADR as differential diagnosis. 61% doctors said they will document ADR in patient file and 78% reports to AMC. More than one-third doctors don’t know where and how to report ADR. One-third doctors felt management of patients was more important than reporting ADR. Nearly one-fourth didn’t report fearing legal liabilities, difficulty diagnosing ADR and negative impact on doctors.Conclusions: Knowledge about ADR-reporting and attitude towards it is adequate. But, because of many barriers, actual practice of ADR-reporting is unsatisfactory. Hence, Pharmacovigilance training is essential for doctors to promote and improve ADR-reporting.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.