Drug prescription pattern in the treatment of heart failure patients admitted at Muhimbili National Hospital

Abstract

Background Heart Failure is one of the common causes of hospitalization in Tanzania and Africa at large. In a study by Kisenge et al. on Pattern of cardiovascular diseases among elderly patients admitted at Muhimbili National Hospital, it was found that 37% of elderly patients admitted were due Congestive Heart Failure. Specific treatment for Heart Failure is crucial for determining outcome in terms of Morbidity and Mortality; however in Tanzania there are no existing evidence-based treatment guidelines to guide clinicians on the management of Heart Failure. Clinicians have adopted guidelines such as the National Institute for health and Clinical Excellence (NICE), American Heart Association (AHA) and European Society of Cardiology (ESC) in the management of patients with Congestive Heart Failure from which the cost and availability of drugs recommended may influence the prescription habits of prescribers. Additionally there is no data on the drug prescription pattern in the treatment of Congestive Heart Failure. Availability of such information may help in the development of practical guidelines in Heart failure management in our setting. Broad Objective To describe the Drug Prescription pattern in the treatment of Heart Failure at Muhimbili National Hospital Study design and Methodology This was a Hospital based descriptive study of consecutive patients admitted in the cardiac unit with a diagnosis of Heart Failure in Mwaisela medical wards at Muhimbili National Hospital between May and October 2013. Patients aged 12 years and above with a diagnosis of Congestive Heart Failure were included in the study. A structured questionnaire was used to obtain information from Patients’ files as recorded at admission and discharge. The information collected included socio-demographic characteristics and labeled cause/s of Heart Failure. Other information collected was named prescribed drugs inclusive of dose, and frequency of administration of drugs as used in the treatment of Heart Failure. Results A total of 150 patients admitted in the cardiac unit at Mwaisela wards with a clinical diagnosis of Heart failure were included in the study. Of these, 54.7% were males and 42% were aged ≥60 years. Dilated Cardiomyopathy, Rheumatic heart disease and Hypertension constituted 75.6% of all the causes for Heart failure in this study. Only 22% of the study patients were re admitted with the same diagnosis of CHF. About 93% of the studied patients presented in severe form of Heart failure (Newyork Heart Association Class III/IV). This study reveals use of eight different pharmacological classes in the treatment of Heart failure at Muhimbili National Hospital. The classes includes Angiotensin converting enzyme inhibitors / Angiotensin receptor blockers (ACE-I/ARB), Beta Blockers(BB), Diuretics(DIUR), Digitalis(DIG), Minerocorticoid receptor antagonists(MRA), Phosphodiesterase type 5 inhibitors(PDE-5) and Vasodilators. Amongst the classes used Diuretics were mostly prescribed being used in 96% of all patients both at admission and discharge. Combination therapy was used in 96% and 98% at admission and at discharge respectively with a two to six combination regimen being in use. At least 3 to 5 drugs were mostly prescribed with 3-4 drugs mainly used at admission increasing to 4-5 drugs at discharge. Patients with severe Heart failure received a large number of drugs. Most combinations contained Enalapril, Aldactone and Isosorbide Mononitrate both at admission and at discharge. Cardiologists and specialist physicians appeared to have similar prescription of Heart failure drugs as recommended by various standard Heart failure treatment guidelines. Conclusions 1. Majority of patients are admitted with severe Heart failure 2. Readmission rate is relatively low 3. Three to five drug therapy is mostly used by clinicians 4. Prescriptions containing key HF drugs(ACEI/ARB,BB and MRA) is low 5. Prescriptions containing Isosorbide dinitrate/hydrallazine combination was low

Recommendations 1. Establishment of a hospital based HF treatment guideline 2. It is high time to establish a heart failure auditing system at MNH 3. There is a need for senior physicians to review prescriptions at discharge so as to avoid single drug use in severely ill patients