Cardiovascular diseases (CVDs) comprise disorders affecting the heart and blood vessels, including coronary artery disease, hypertension, heart failure, myocardial infarction, arrhythmias, and valvular heart diseases. According to global estimates, cardiovascular diseases account for approximately one-third of all deaths annually. India is experiencing a rapid increase in cardiovascular disease burden due to urbanization, sedentary lifestyles, obesity, diabetes mellitus, smoking, alcohol consumption, unhealthy dietary habits, and aging populations. Drug utilization research evaluates the prescribing, dispensing, and consumption of medicines in society with special emphasis on medical, social, and economic outcomes. The World Health Organization (WHO) recommends periodic drug utilization studies to assess rational prescribing practices. Prescription pattern monitoring studies help identify polypharmacy, inappropriate prescribing, excessive antibiotic use, irrational combinations, and deviations from standard treatment guidelines. Such studies provide valuable information for clinicians and hospital administrators to improve healthcare quality. Drug utilization evaluation (DUE) studies are intended to survey the appropriateness of drug usage. DUE is important to understand that improper use of drugs can have potential risks and additional costs for patients. [1] It is an executive approach used to improve the usage of medications as well as reduce the cost of treatment, ensure drug adequacy, and improve patient safety. [2] The World Health Organization (WHO) reports an estimated 17.9 cardiovascular million disease people died from (CVDs) in 2016, representing 31% of all global deaths, of these deaths 85% are due to heart attack and stroke. [3] The WHO has estimated that the current burden of CVD in India would lose $237 billion from the loss of productivity and spending on health care over a 10-year period 2005–2015, [4] deaths from CVDs are predicted to rise to almost 50 million in India. According to the WHO, more than 50% of all medicines are prescribed, dispensed or sold inappropriately, on the other side, 50% of patients take them incorrectly and about one-third of the world’s population lacks access to essential medicines. [5] Prescription is a critical issue in the rational treatment. [6] Study of prescription patterns is an important to determine rationality of drug therapy and to maximize the utilization of resources. [7] The prescribing pattern reflects the physician’s knowledge about the disease process and application of pharmacotherapeutics. [8] Studies on drug utilization pattern (DUP) have become a potential tool to be used in the evaluation of healthcare system. [9] Drug utilization research encourages rational prescribing of drug, contributes to the knowledge of current use of drugs in the society and explore whether a particular intervention affects the drug use in the population by observing the drug use pattern. By the end of 2018, India is predicted to be heart disease capital of the world with estimated rise of 111% in cardiovascular deaths. [10] Cardiovascular mortality rates in India are higher than the global average (272 vs. 235 per 1,00,000).[11] Despite such alarming projections, there is paucity of quality data on cardiovascular diseases (CVDs) in Indian population.[12] The aim of the present study was to evaluate the drug utilization in cardiovascular disease at a teaching hospital.

The present study was conducted in Venkateshwara Institute of Medical Sciences, Gajraula, India for the period of 6 months. A total of 200 prescriptions of the patients attending hospital OPD of the selected hospitals over a period of 6 months were randomly identified and included in this study according to the inclusion criteria then critically analyzed using WHO core prescribing indicators, particularly different types of drugs prescribed and their prescribing pattern was determined. Prescriptions of patients with age < 30 and >80, pregnancy, lactation, critically ill patients, patients with lifestyle modification alone, prescriptions of outpatients of other departments, prescriptions of patients diagnosed with non-cardiac diseases, prescriptions of patients those not willing to participate were excluded from this study. Ethical Considerations The study protocol was submitted to the Institutional Ethics Committee (IEC) for approval before initiation of the study. Permission to conduct the study was obtained from the Head of the Department of Cardiology and the Medical Superintendent of the hospital. Written informed consent was obtained from patients whenever required according to institutional policy. Patient confidentiality was maintained throughout the study by assigning unique identification numbers instead of recording names or personal identifiers. The collected data were used only for academic and research purposes. Statistical analysis The data was collected, compiled in MS-Excel, and analyzed for counts and percentages. The mean and standard deviation was computed for continuous variables. Graphical representation has been used for visual interpretation of the analyzed data.

Table 1: Age- and gender-wise distribution of CVD patients Age in years No. of patients % Male Female 30–40 28 14 20 8 41–50 50 25 35 15 51–60 64 32 40 24 61–70 36 18 18 18 71–80 22 11 10 12 Total 200 100 123 77 Based on the results obtained it is found that male patients 61.5% had high frequency of cardiovascular incidences when compared to female patients 38.5%. Out of 200 patients, 32% of patients belong to the age group of 51–60 years which was considered to be highest percentage when compared to all other age groups and 11% of patients present in the age group of 71–80 years which were considered to be lowest percentage among all age groups, these demographic data reveal the influence of gender and age in disease and prescribing pattern. Table 2: Distribution of selected risk factors in cardiovascular disease patients and Percentages of drug utilization pattern in cardiovascular disease patients Risk factors N % Inadequate diet 10 5 Physical inactivity 12 6 Tobacco consumption 32 16 Alcoholics 40 20 Obesity 60 30 Drug utilization pattern FDC 40 20 DPS 160 80 During this study, different adjustable risk factors associated with CVDs were also observed in the patients particularly 5% of inadequate diet, 6% of physical inactivity, 16% of tobacco consumption, 20% of alcoholics, and 30% of obesity. In our study, a total of 40 (20%) of prescribed drugs were found to be FDCs, rest of the drugs 160 (80%) were prescribed as single dose. Table 3: Commonly prescribed fixed dose combinations in cardiovascular disease patients Class Fixed dose combinations Strength (mg) % Antiplatelet drugs Aspirin+Clopidogrel 75+75 40 ARB/Diuretic Telmisartan + Hydrochlorothiazide 40+12.5 15 CCB/BB Amlodipine+Atenolol 5+50 10 ACEI/Diuretic Ramipril+Hydrochlorothiazide 2.5+12.5 6 ARB/BB Telmisartan+Metoprolol 40+50 4 ARB/Diuretic Losartan+Hydrochlorothiazide 50+12.5 3 CCB/ARB Amlodipine+Losartan 40+5 3 Aspirin + Clopidogrel combination is found to be highly prescribed FDC (40%) among all, next to that Telmisartan + Hydrochlorothiazide (15%) and Amlodipine + Atenolol (10%) were highly prescribed.

The World Health Organization (WHO) reports an estimated 17.9 million people died from cardiovascular disease (CVDs) in 2016, representing 31% of all global deaths, of these deaths 85% are due to heart attack and stroke. [13] The WHO has estimated that the current burden of CVD in India would lose $237 billion from the loss of productivity and spending on health care over a 10-year period 2005–2015, [14] deaths from CVDs are predicted to rise to almost 50 million in India. According to the WHO, more than 50% of all medicines are prescribed, dispensed or sold inappropriately, on the other side, 50% of patients take them incorrectly and about one-third of the world’s population lacks access to essential medicines. [15] Based on the results obtained it is found that male patients 61.5% had high frequency of cardiovascular incidences when compared to female patients 38.5%. Out of 200 patients, 32% of patients belong to the age group of 51–60 years which was considered to be highest percentage when compared to all other age groups and 11% of patients present in the age group of 71–80 years which were considered to be lowest percentage among all age groups, these demographic data reveal the influence of gender and age in disease and prescribing pattern. This was comparable to age-related distribution of CVDs demonstrated in similar studies from Guntur (Andhra Pradesh) [16] and Kattankulathur (Tamil Nadu) [17]; such results strengthen the findings of previous studies that have shown high incidence of CVDs in elderly people. During this study, different adjustable risk factors associated with CVDs were also observed in the patients particularly 5% of inadequate diet, 6% of physical inactivity, 16% of tobacco consumption, 20% of alcoholics, and 30% of obesity. In our study, a total of 40 (20%) of prescribed drugs were found to be FDCs, rest of the drugs 160 (80%) were prescribed as single dose. It was found that most of practitioners prefer FDCs, only in certain circumstances and is purely case dependent. FDCs are found to have some advantages such as increasing patient compliance by bring about synergistic action which can reduce the dose of the individual component and adverse effects. On the other hand, rationality of FDCs has become one of the most controversial and debatable issues in general practice. [18] Aspirin + Clopidogrel combination is found to be highly prescribed FDC (40%) among all, next to that Telmisartan + Hydrochlorothiazide (15%) and Amlodipine + Atenolol (10%) were highly prescribed. There are unfortunately no worldwide acceptable criteria to define irrational FDCs and no uniform principles or international standards for their development and regulatory assessment. [19].

Polypharmacy and least use of generic name were observed in the study which may affect the rationality. The use of antiplatelets, statins, and angiotensin-converting enzyme-inhibitors was appropriate, but furosemide overuse is of major concern. Therefore, appropriate prescription writing improvises treatment compliance in the patients, which results in rationality.

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