Assessment of drug utilization pattern and rationality of drug use in treatment of dilated cardiomyopathy in a tertiary care teaching hospital of rural Bengal

Abstract

Background: Dilated cardiomyopathy (DCM) is an important underlying cause of congestive heart failure and/or arrhythmias. The introduction of therapy combining diuretics, digoxin and angiotensin converting enzyme inhibitors (ACEI) has significantly decreased mortality and morbidity. The aim of the study was undertaken to identify the pattern of drugs most commonly prescribed for DCM and to assess the rationality behind such use.Methods: This was a prospective study undertaken between 1st July and 31st August 2015. Prescriptions were reviewed and analyzed using the World Health Organization (WHO) indicators for drug utilization studies. Rationality and cost of therapy per prescription was also evaluated.Results: We encountered 78 patients of DCM in the OPD of Cardiology (prevalence of 4.94%). The average number of drugs per prescription was 6.64. Generic prescriptions were made in 90% encounters. As part of therapy, diuretics and ACE inhibitors or angiotensin receptor blockers, were prescribed in all cases. Our results show a distinctive drug use pattern where beta blockers were used more commonly than digoxin. Other commonly prescribed agents were antiplatelet drugs and statins. Antibiotics were prescribed in 8.7% cases and no injectable drug was prescribed. Average drug cost per encounter was 10.63 INR.Conclusions: To conclude, we found a typical and rational pattern of drug use. Diuretics, ACEI and beta blockers were found to be most commonly used agents. This study provides a clear picture of drug use in this special clinical condition in rural Bengal and paves the way for larger and long term studies.

Dilated cardiomyopathy: a pharmacotherapeutic research

“…Similarly, in a study conducted by Banerjee P et al it was reported that Diuretics were prescribed to all the patients with Spironolactone being the most commonly prescribed agent. 13 As per the study conducted by Kurtoglu E et al, among beta blockers Metoprolol or Carvedilol remains a more rational choice in these cases. 15 Similarly another study conducted by Banerjee P et al, reports Beta blocker prescriptions to be about 93.58% in their study with Carvedilol being the most commonly prescribed drug.…”

“…15 Similarly another study conducted by Banerjee P et al, reports Beta blocker prescriptions to be about 93.58% in their study with Carvedilol being the most commonly prescribed drug. 13 Where as in a small randomized, placebo controlled trial conducted by Yeoh T et al, in patients with suspected early familial DCM, there was no significant improvement in cardiac function with carvedilol, although benefit is suggested with longer term follow-up. 16 In contrast our study shows about 42.85% prescriptions of Beta blockers with Bisoprolol being the only prescribed agent in the patients with DCM.…”

“…In contrast the study conducted by Banerjee P et al, states that 48.71% population encountered in their study was aged between 50-60 years and 17.94% patients were over 60 years. 13 As per the literature stated by Hamayak Sisakian, DCM has no specific etiology-based therapy. The general concepts of Chronic Heart Failure treatment forms a part of DCM therapy, with regard to etiopathogenesis conventional pharmacotherapy is not specific but it reduces mortality in these patients.…”

“…In contrast a study conducted by Banerjee P et al states that ACEI or ARBs with Ramipril being the most common was prescribed in almost all the patients. 13 In another study conducted by Yusuf S et al, emphasizes as per HOPE trial that ACE inhibitors provide an essential cardiovascular benefit in this group of patients. 19 Digoxin (Cardiac Glycoside) was prescribed in 21.42% patients in the present study which is higher when compared to 5.4% in a study conducted by Banerjee P et al 13 Digoxin plays a prominent role in the management of patients with heart failure and this could be the possible reason for it being prescribed here.…”

“…17 Adding further, Bisoprolol inhibits renin secretion by 65% which is additional to other beta blockers. 18 Antiplatelet and Anti hyperlipidaemics were given to 64.28% patients (agents include Aspirin or Clopidogrel along with Atorvastatin); among them Dual Antiplatelet therapy was given to 35.71% patients which is quite low compared to 92.3% Antiplatelet prescriptions (mostly Aspirin) in the study conducted by Banerjee P et al 13 ACEI (Ramipril) and ARBs (Telmisartan) were prescribed in only 7.14% patients each. In contrast a study conducted by Banerjee P et al states that ACEI or ARBs with Ramipril being the most common was prescribed in almost all the patients.…”