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\def\citeauthor{~Krishna~Sumanth~K,
              ~Sahithi~Maroju,
              ~Deeksha~Kolliparla,
              ~Shravya~Mancharla,
              ~Richard~Noah}
\def\citetitle{Prescription Pattern of Coronary Artery Disease in a Tertiary Care Hospital: A Retrospective Observational Study}
\def\copyrightstmt{This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial- ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.}
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\def\RunningAuthor{Sahithi Maroju et al.}
\firstPage{115}
\articleType{Original Article}
\receivedDate{15 Oct 2021}
\acceptedDate{28 Oct 2021}
\revisedDate{26 Oct 2021}
\journalVolume{1}
\journalIssue{3}
\copyrightYear{2021}
\eISSN{2583-0953}
\journalDoi{10.26452/ijcpms.v1i3.234}
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\def\journalTitle{International Journal of Clinical Pharmacokinetics and Medical Sciences}

\title{Prescription Pattern of Coronary Artery Disease in a Tertiary Care Hospital: A Retrospective Observational Study}
\author{Krishna~Sumanth~K\textsuperscript{1},  
            Sahithi~Maroju\textsuperscript{*}\textsuperscript{2},  
            Deeksha~Kolliparla\textsuperscript{2},  
            Shravya~Mancharla\textsuperscript{2}, 
            Richard~Noah\textsuperscript{3}~\\[5pt]{\textsuperscript{1}Apollo Hospitals, Filmnagar, Hyderabad, Telangana, India}~\\{\textsuperscript{2}Sree Dattha Institute of Pharmacy, Sheriguda, Telangana, India}~\\{\textsuperscript{3}HKES College of Pharmacy, Gulbarga, Karnataka, India}}

\begin{abstract}
The study's major goal is to look at the current prescribing patterns for medications used in the treatment of coronary heart disease at the research location. The goal of this study's drug use research was to make it easier for a specialised set of people to utilise medications rationally. In the Medicine ward, an observational retrospective study was done over a six-month period. Patients who consult a cardiologist for heart abnormalities are checked, diagnosed, and recommended appropriate treatment. The most common lipid-lowering medication was rosuvastatin (53.84 percent), followed by atorvastatin (46.15 percent). Antihypertensive medications are commonly used by patients. Beta blockers, ACE inhibitors, and diuretics were the most popular options. Adrenergic receptor blockers are used to treat hypertension patients. Metprolol and bisprolol were prescribed by the majority of doctors (57.7\%). (8.8 percent ). Carvidilol, on the other hand, is rarely given (31.1 percent). ACE inhibitors stood a good chance of being prescribed. Enalapril was given to the majority of the patients (66.6 percent). Eplirinone (38.2\%) and furosemide (38.2\%) were the doctors' second and third choices, respectively (32.3 percent). The majority of patients were men, which could be due to smoking and drinking tendencies. When compared to other types of cardiovascular drugs, statins and anti-atherogenic therapies are the most common. Beta-blockers, ACE inhibitors, and diuretics are commonly used by hypertension patients. 
\end{abstract}\def\keywordstitle{Keywords}

\begin{keywords}Coronary Heart Disease,\newline Prescribing Pattern,\newline Drug Utilization
\end{keywords}
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\makeatletter{\raggedright{\Large$^\ast$}Corresponding Author\par Name:\ Sahithi~Maroju~\\ Phone:\ ~\\  Email:\ marojusahithi@gmail.com
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\section{Introduction}
Coronary artery disease is a disorder in which atheroma, thrombosis, or spasm of coronary arteries obstructs the circulatory supply to the heart \unskip~\cite{1246906:23494225,1246906:23494340,1246906:23494343}. CVDs are the world's most common noncommunicable diseases, as well as the major cause of mortality and disability. CVDs kill more people each year than any other cause \unskip~\cite{1246906:23494354}. The following are some modifiable risk factors:

\textbf{Hypertension}

Hypertension can be cured, but only if it is detected and treated according to the doctor's instructions \unskip~\cite{1246906:23494420}.

\textbf{Cholesterol}

High total cholesterol, elevated triglyceride levels, high levels of low-density lipoprotein (LDL) cholesterol, and low levels of high density lipoprotein (HDL) cholesterol all increased the risk of heart disease and stroke \unskip~\cite{1246906:23494420}.

\textbf{Diabetes}

Developing cardiovascular disease at a younger age than others is more common, diabetes is uncontrolled, and the consequences are more severe \unskip~\cite{1246906:23494420}.

\textbf{Tobacco}

Passive smoking, on the other hand, is a risk factor for cardiovascular disease. Tobacco abstinence may reduce the risk of cardiovascular disease \unskip~\cite{1246906:23494420}.

\textbf{Diet}

Low consumption of fruits, vegetables, and seafood, as well as high consumption of salt, saturated fat, and trans-fats, has been related to an increased risk of cardiovascular disease. Trans-fat consumption has a negative impact on blood lipids and circulating inflammatory markers \unskip~\cite{1246906:23494421,1246906:23494424}. Processed meat consumption is connected to an increased risk of cardiovascular disease, possibly due to increased dietary salt consumption \unskip~\cite{1246906:23494426}.

\textbf{Alcohol Consumption}

Moderate drinking without a history of binge drinking has been associated to a lower risk of cardiovascular disease \unskip~\cite{1246906:23494479,1246906:23494480}.

Medicines like contraceptive pills and hormone replacement treatment can potentially increase the risk of heart disease. The following are some non-modifiable risk factors:

\textbf{Genetics}

Having a parent with cardiovascular disease increases a person's risk by three times \unskip~\cite{1246906:23494533}.

\textbf{Age}

It is estimated that 82 percent of persons 65 and older die of coronary heart disease \unskip~\cite{1246906:23494537}. Meanwhile, the risk of stroke doubles every decade after the age of 55 \unskip~\cite{1246906:23494539}. The rise in women lasts until they are 60 to 65 years old \unskip~\cite{1246906:23494543}.

\textbf{Sex}

Males are more likely than premenopausal women to get heart disease \unskip~\cite{1246906:23494917}. When a woman reaches menopause, it has been believed that her risk is similar to that of a man. 

However, current evidence from the WHO and the United Nations contradicts this \unskip~\cite{1246906:23495013}. Middle-aged males are two to five times more likely than women to suffer from coronary heart disease \unskip~\cite{1246906:23495071}.

\textbf{Treatment}

Both caregivers and patients with heart disease must be able to comprehend the prescribed drug, follow the instructions for use, and be aware of any potential side effects. 

The following are the most commonly recommended medications for cardiac disease \unskip~\cite{1246906:23495074}:

\textbf{Angiotensin Converting Enzyme (ACE)}

Angiotensin II is a hormone that causes blood vessels to constrict or shrink \unskip~\cite{1246906:23495363}. Benazepril is an example of a regularly prescribed medicine. Captopril, Enalapril, Fosinopril, Lisinopril, Moexipril, Perindopril, Quinapril, Ramipril, Trandolapril are the examples of ACE inhibitors.

\textbf{Angiotensin II Receptor Blockers (ARB)}

Angiotensin receptor blockers, unlike angiotensin converting enzyme inhibitors, totally block the action of Angiotensin II on the heart \unskip~\cite{1246906:23495450}. Candesartan , Eprosartan , Irbesartan, Losartan , Telmisartan, Valsartan are the examples.

\textbf{Anti-Coagulants}

Anticoagulants (blood thinners) can prevent blood clots from developing but do not dissolve existing blood clots \unskip~\cite{1246906:23495455}. Rivaroxaban, Dabigatran, Apixaban, Heparin, and Warfarin are some of the most commonly prescribed medications \unskip~\cite{1246906:23495456}.

\textbf{Antiplatelets}

These are given to people who have had a cardiac event, such as a heart attack \unskip~\cite{1246906:23495457}. The following are some examples of frequently prescribed drugs: Ticagrelor, Aspirin, Clopidogrel, Dipyridamole, Prasugrel, Dipyridamole, Prasugrel are the examples \unskip~\cite{1246906:23495682}.

\textbf{Beta Blockers}

They reduce the generation of toxic compounds produced by the body in reaction to heart failure by blocking the effects of adrenaline (epinephrine). 

This improves the heart's ability to work. {\textendash} Acebutolol, Atenolol, Bisprolol, Betaxolol, Metoprolol, Nadolol, Propranolol, Sotalol are the examples \unskip~\cite{1246906:23495683}.

\textbf{Calcium Channel Blockers (CCB)}

Calcium channel blockers can be used in different parts of the body for different purposes depending on the individual's health condition or disorders \unskip~\cite{1246906:23495707}. 

Amlodipine, Diltiazem, Felodipine, Nifedipine, Nimodipine, Nisoldipine, and Verapamil are some of the most commonly given medicines \unskip~\cite{1246906:23495749}.

\textbf{Anti-Hyperlipidemics}

Cholesterol deposits in blood vessels can lead to plaque formation, constricting blood vessels. If a blood clot forms around the plaque rupture, it might break off and obstruct the blood vessel. 

The following are some examples of cholesterol-lowering medications: 

Atorvastatin, Pravastatin sodium, and Simvastatin are statins.

\textbf{Vasodilators}

Calcium channel blockers can be used in different parts of the body for different purposes depending on the individual's health condition or disorders \unskip~\cite{1246906:23495707}. Amlodipine, Diltiazem, Felodipine-Nifedipine, Nimodipine, Nisoldipine, and Verapamil are some of the most commonly given medicines \unskip~\cite{1246906:23495749}.

\textbf{Anti-Hyperlipidemics}

Cholesterol deposits in blood vessels can lead to plaque formation, constricting blood vessels. If a blood clot forms around the plaque rupture, it might break off and obstruct the blood vessel. The following are some examples of cholesterol-lowering medications: Atorvastatin, Pravastatin sodium, and Simvastatin are statins.

\textbf{Potassium Channel Activators}

A potassium channel opener is a medication that makes it easier for ions to pass through potassium channels. 


  
  \begin{enumerate}
  \item \relax Diazoxide, a vasodilator used to treat hypertension; smooth muscle relaxing action.
  \item \relax Minoxidil is a vasodilator used to treat hypertension and hair loss.
  \item \relax Nicorandil is a vasodilator that is used to treat angina pectoris.
  \end{enumerate}
  \textbf{Drug Prescription Pattern}

The ability of health professionals to discriminate between many pharmacological options and identify which ones will assist their patients is reflected in their prescribing pattern. Prescription writing is both an art and a science, as it conveys the physician's message to the patient. It is an order for a member to receive scientific medication at a specific time. The study of prescribing patterns is a type of medical review that aims to monitor, assess, and, if required, propose changes to prescribing practises in order to make medical care more reasonable and cost effective. Contrary drug use studies are important tools for determining whether medications are used appropriately in terms of sufficiency, safety, convenience, and cost at all stages of the pharmaceutical process.

\textbf{Drug Utilization}

National drug policy, illiteracy, poverty, the use of multiple health-care systems, drug marketing and promotion, the sale of prescription drugs without a prescription, competition in the medical and pharmaceutical markets, and the limited availability of independent, unbiased drug information are all examples of these issues in India. Unwise drug use can lead to an increase in medical problems, antimicrobial resistance, side effects, and patient mortality. As a result, recent studies on drug consumption have evolved into a possible criterion for evaluating health systems. Because of increased marketing of new pharmaceuticals, deep differences in the pattern of drug prescribing and utilisation, rising concern about delayed adverse effects, and mounting concern about drug charges, the importance has grown since then.


\bgroup
\fixFloatSize{images/e1486928-d0a1-4cb6-b79c-308b65dcc772-upicture1.png}
\begin{figure}[!htbp]
\centering \makeatletter\IfFileExists{images/e1486928-d0a1-4cb6-b79c-308b65dcc772-upicture1.png}{\includegraphics{images/e1486928-d0a1-4cb6-b79c-308b65dcc772-upicture1.png}}{}
\makeatother 
\caption{\boldmath {Prevalence of Coronary Artery Disease in the Given Population}}
\label{f-f4e909288fba}
\end{figure}
\egroup

\bgroup
\fixFloatSize{images/73af471f-b932-4e85-b34d-16bfa91850f8-upicture2.png}
\begin{figure}[!htbp]
\centering \makeatletter\IfFileExists{images/73af471f-b932-4e85-b34d-16bfa91850f8-upicture2.png}{\includegraphics{images/73af471f-b932-4e85-b34d-16bfa91850f8-upicture2.png}}{}
\makeatother 
\caption{\boldmath {Column Chart on Age Wise Distribution Among CAD patients}}
\label{f-277a40bac0ab}
\end{figure}
\egroup

\bgroup
\fixFloatSize{images/e22eddd8-55e8-41c8-8cec-600fdd0b87e5-upicture3.png}
\begin{figure}[!htbp]
\centering \makeatletter\IfFileExists{images/e22eddd8-55e8-41c8-8cec-600fdd0b87e5-upicture3.png}{\includegraphics{images/e22eddd8-55e8-41c8-8cec-600fdd0b87e5-upicture3.png}}{}
\makeatother 
\caption{\boldmath {Bar Chart on the Prescribing Patterns of Physician}}
\label{f-dadf99047afb}
\end{figure}
\egroup

\begin{table*}[!htbp]
\caption{\boldmath {Gender Wise Distribution of CAD Patients} }
\label{tw-55cae7e9abbe}
\def\arraystretch{1.1}
\ignorespaces 
\centering 
\begin{tabulary}{\linewidth}{p{\dimexpr.17150000000000002\linewidth-2\tabcolsep}p{\dimexpr.1738\linewidth-2\tabcolsep}p{\dimexpr.4182\linewidth-2\tabcolsep}p{\dimexpr.2365\linewidth-2\tabcolsep}}
\tbltoprule \rowcolor{kwdboxcolor}\cAlignHack S. No. & \cAlignHack Sex & \cAlignHack Number of Patients (n=100) & \cAlignHack Percentage (\%)\\
\tblmidrule 
\cAlignHack 1. &
  \cAlignHack Male &
  \cAlignHack 60 &
  \cAlignHack 60\%\\
\cAlignHack 2. &
  \cAlignHack Female &
  \cAlignHack 40 &
  \cAlignHack 40\%\\
\tblbottomrule 
\end{tabulary}\par 
\end{table*}

\begin{table*}[!htbp]
\caption{\boldmath {Surgical Procedures Observed in the Study Population} }
\label{tw-bcccd94d6d3e}
\def\arraystretch{1.1}
\ignorespaces 
\centering 
\begin{tabulary}{\linewidth}{p{\dimexpr.12\linewidth-2\tabcolsep}p{\dimexpr.34190000000000005\linewidth-2\tabcolsep}p{\dimexpr.3352000000000001\linewidth-2\tabcolsep}p{\dimexpr.2029\linewidth-2\tabcolsep}}
\tbltoprule \rowcolor{kwdboxcolor}\cAlignHack Sl.no. & \cAlignHack Name of the surgical procedure & \cAlignHack Number of patients(n=124 ) & \cAlignHack Percentage (\%)\\
\tblmidrule 
\cAlignHack 1. &
  \cAlignHack Coronary angiogram &
  \cAlignHack 86 &
  \cAlignHack 69.3\%\\
\cAlignHack 2. &
  \cAlignHack Percutaneous tramsluminal coronary Angioplasty. &
  \cAlignHack 36 &
  \cAlignHack 29.03\%\\
\cAlignHack 3. &
  \cAlignHack Coronary artery bypass grafting &
  \cAlignHack 02 &
  \cAlignHack 1.61\%\\
\tblbottomrule 
\end{tabulary}\par 
\end{table*}

\begin{table*}[!htbp]
\caption{\boldmath {Cross Tabulation on Medical Condition and No. of Patients} }
\label{tw-13172128c0a9}
\def\arraystretch{1.1}
\ignorespaces 
\centering 
\begin{tabulary}{\linewidth}{p{\dimexpr.13770000000000001\linewidth-2\tabcolsep}p{\dimexpr.3309\linewidth-2\tabcolsep}p{\dimexpr.315\linewidth-2\tabcolsep}p{\dimexpr.2164\linewidth-2\tabcolsep}}
\tbltoprule \rowcolor{kwdboxcolor}\cAlignHack Sl.no. & \cAlignHack Medical Condition & \cAlignHack Number of Patients (n=100) & \cAlignHack Percentage (\%)\\
\tblmidrule 
\cAlignHack 1 &
  \cAlignHack Diabetes mellitus &
  \cAlignHack 38 &
  \cAlignHack 38\%\\
\cAlignHack 2 &
  \cAlignHack Obesity &
  \cAlignHack 1 &
  \cAlignHack 1\%\\
\cAlignHack 3 &
  \cAlignHack Renal disorders &
  \cAlignHack 3 &
  \cAlignHack 3\%\\
\cAlignHack 4 &
  \cAlignHack Metabolic acidosis &
  \cAlignHack 1 &
  \cAlignHack 1\%\\
\cAlignHack 5 &
  \cAlignHack Hypothyroidism &
  \cAlignHack 3 &
  \cAlignHack 3\%\\
\cAlignHack 6 &
  \cAlignHack Anemia &
  \cAlignHack 1 &
  \cAlignHack 1\%\\
\cAlignHack 7 &
  \cAlignHack Osteoarthritis &
  \cAlignHack 1 &
  \cAlignHack 1\%\\
\cAlignHack 8 &
  \cAlignHack COPD &
  \cAlignHack 2 &
  \cAlignHack 2\%\\
\cAlignHack 9 &
  \cAlignHack Others &
  \cAlignHack 10 &
  \cAlignHack 10\%\\
\cAlignHack 10 &
  \cAlignHack NONE &
  \cAlignHack 39 &
  \cAlignHack 39\%\\
\tblbottomrule 
\end{tabulary}\par 
\end{table*}

\begin{table*}[!htbp]
\caption{\boldmath {Cross Tabulation Prescribed Drugs and No. of Drugs Given} }
\label{tw-9415c1a01861}
\def\arraystretch{1.1}
\ignorespaces 
\centering 
\begin{tabulary}{\linewidth}{p{\dimexpr.1424\linewidth-2\tabcolsep}p{\dimexpr.3619999999999999\linewidth-2\tabcolsep}p{\dimexpr.26570000000000004\linewidth-2\tabcolsep}p{\dimexpr.2299\linewidth-2\tabcolsep}}
\tbltoprule \rowcolor{kwdboxcolor}\cAlignHack S.No. & \cAlignHack Prescribed Drugs & \cAlignHack No. of Drugs & \cAlignHack Percentage (\%)\\
\tblmidrule 
\cAlignHack 1. &
  \cAlignHack \textbf{Lipid lowering agents} &
  \cAlignHack \textbf{91} &
  \cAlignHack \\
\cAlignHack  &
  \cAlignHack Rosuvastatin &
  \cAlignHack 49 &
  \cAlignHack 53.84\%\\
\cAlignHack  &
  \cAlignHack Atorvastatin &
  \cAlignHack 42 &
  \cAlignHack 46.15\%\\
\cAlignHack  &
  \cAlignHack  &
  \cAlignHack  &
  \cAlignHack \\
\cAlignHack 2. &
  \cAlignHack Anti-platelets &
  \cAlignHack \textbf{117} &
  \\
\cAlignHack  &
  \cAlignHack Aspirin &
  \cAlignHack 56 &
  \cAlignHack 57.8\%\\
\cAlignHack  &
  \cAlignHack Clopidogrel &
  \cAlignHack 44 &
  \cAlignHack 37.6\%\\
\cAlignHack  &
  \cAlignHack Ticagrelor &
  \cAlignHack 14 &
  \cAlignHack 11.9\%\\
\cAlignHack  &
  \cAlignHack Tirofiban &
  \cAlignHack 3 &
  \cAlignHack 2.56\%\\
\cAlignHack  &
  \cAlignHack  &
  \cAlignHack  &
  \cAlignHack \\
\cAlignHack 3. &
  \cAlignHack \textbf{Anticoagulants} &
  \cAlignHack \textbf{34} &
  \\
\cAlignHack  &
  \cAlignHack Heparin &
  \cAlignHack 22 &
  \cAlignHack 64.7\%\\
\cAlignHack  &
  \cAlignHack Enoxaparin &
  \cAlignHack 10 &
  \cAlignHack 29.4\%\\
\cAlignHack  &
  \cAlignHack Rivaroxaban &
  \cAlignHack 1 &
  \cAlignHack 2.9\%\\
\cAlignHack  &
  \cAlignHack  &
  \cAlignHack  &
  \cAlignHack \\
\cAlignHack 4. &
  \cAlignHack \textbf{ACE Inhibitors} &
  \cAlignHack \textbf{3} &
  \\
\cAlignHack  &
  \cAlignHack Enalapril &
  \cAlignHack 2 &
  \cAlignHack 66.6\%\\
\cAlignHack  &
  \cAlignHack Lisinopril &
  \cAlignHack 1 &
  \cAlignHack 33.3\%\\
\cAlignHack  &
  \cAlignHack  &
  \cAlignHack  &
  \cAlignHack \\
\cAlignHack 5. &
  \cAlignHack \textbf{ARB} &
  \cAlignHack \textbf{33} &
  \\
\cAlignHack  &
  \cAlignHack Telmisartan &
  \cAlignHack 20 &
  \cAlignHack 60.6\%\\
\cAlignHack  &
  \cAlignHack Olmesartan &
  \cAlignHack 7 &
  \cAlignHack 21.21\%\\
\cAlignHack  &
  \cAlignHack Valsartan &
  \cAlignHack 3 &
  \cAlignHack 9.09\%\\
\cAlignHack  &
  \cAlignHack Losartan &
  \cAlignHack 3 &
  \cAlignHack 9.09\%\\
\cAlignHack  &
  \cAlignHack  &
  \cAlignHack  &
  \cAlignHack \\
\cAlignHack 6. &
  \cAlignHack \textbf{Anti-Anginal Drugs} &
  \cAlignHack \textbf{34} &
  \\
\cAlignHack  &
  \cAlignHack Nitroglycerin &
  \cAlignHack 17 &
  \cAlignHack 50\%\\
\cAlignHack  &
  \cAlignHack Trimetazidine &
  \cAlignHack 13 &
  \cAlignHack 38.2\%\\
\cAlignHack  &
  \cAlignHack Isosorbate Dinitrate &
  \cAlignHack 14 &
  \cAlignHack 41.1\%\\
\cAlignHack  &
  \cAlignHack  &
  \cAlignHack  &
  \cAlignHack \\
\cAlignHack 7. &
  \cAlignHack \textbf{Beta Blockers} &
  \cAlignHack \textbf{45} &
  \\
\cAlignHack  &
  \cAlignHack Metoprolol &
  \cAlignHack 26 &
  \cAlignHack 57.7\%\\
\cAlignHack  &
  \cAlignHack Bisprolol &
  \cAlignHack 4 &
  \cAlignHack 8.8\%\\
\cAlignHack  &
  \cAlignHack Carvidilol &
  \cAlignHack 14 &
  \cAlignHack 31.1\%\\
\cAlignHack  &
  \cAlignHack Nebivolol &
  \cAlignHack 1 &
  \cAlignHack 2.2\%\\
\cAlignHack  &
  \cAlignHack  &
  \cAlignHack  &
  \cAlignHack \\
\cAlignHack 8. &
  \cAlignHack \textbf{Calcium Channel Blockers} &
  \cAlignHack \textbf{15} &
  \\
\cAlignHack  &
  \cAlignHack Amlodipine &
  \cAlignHack 9 &
  \cAlignHack 60\%\\
\cAlignHack  &
  \cAlignHack Diltiazem &
  \cAlignHack 2 &
  \cAlignHack 13.3\%\\
\cAlignHack  &
  \cAlignHack Cilnidipine &
  \cAlignHack 3 &
  \cAlignHack 20\%\\
\cAlignHack  &
  \cAlignHack Nifidipine &
  \cAlignHack 1 &
  \cAlignHack 6.6\%\\
\cAlignHack  &
  \cAlignHack  &
  \cAlignHack  &
  \cAlignHack \\
\cAlignHack 9. &
  \cAlignHack \textbf{Diuretics} &
  \cAlignHack \textbf{34} &
  \\
\cAlignHack  &
  \cAlignHack Eplirinone &
  \cAlignHack 13 &
  \cAlignHack 38.2\%\\
\cAlignHack  &
  \cAlignHack Furosemide &
  \cAlignHack 11 &
  \cAlignHack 32.3\%\\
\cAlignHack  &
  \cAlignHack Torsemide &
  \cAlignHack 9 &
  \cAlignHack 26.4\%\\
\cAlignHack  &
  \cAlignHack Metolazone &
  \cAlignHack 1 &
  \cAlignHack 2.9\%\\
\tblbottomrule 
\end{tabulary}\par 
\end{table*}
\textbf{Types of Drug Utilization Studies}

In addition, drug utilisation studies can be qualitative or quantitative. Qualitative drug utilisation studies are a multidisciplinary process that gathers, organises, analyses, and reports data on actual drug usage. The collection, organising, and demonstration of estimates or measurements of drug usage are all part of quantitative drug utilisation research.

\textbf{Sources of Data on Drug Utilization}

Data about drug usage can be found in the following places:
  
  \begin{enumerate}
  \item \relax Data from drug regulatory bodies.
  \item \relax Data from suppliers (distribution)
  \item \relax Data on practise settings 
  \item \relax Data on prescribing and dispensing
  \item \relax Drug usage assessment
  \end{enumerate}
  
    
\section{METHODOLOGY}
\textbf{Study Design}

This is a 6-month retrospective and prospective observational study that took place at the inpatient cardiology department of a tertiary care hospital, Aware Gleneagles Global Hospital.

\textbf{Collection of Data}

Relevant details of every in-patient with coronary artery disease were collected in a specially constructed Performa to analyze prescribing patterns. The demographic data), as well as the diagnostic data, were gathered from each patient's in-patient case records. 

Also highlighted in the medical records were linked co-morbid diseases and risk factors for developing coronary artery disease. 

The drug information was recorded, including the substances, dosage form, dose, mode of administration, and frequency.

\textbf{Inclusion Criteria}

The study comprised all in-patients diagnosed with coronary artery disease in the cardiology unit by a consultant cardiologist.

\textbf{Exclusion Criteria}


  
  \begin{enumerate}
  \item \relax Patients who were managed in a day care facility.
  \item \relax Women who are pregnant or nursing.
  \item \relax Patients who have been diagnosed with additional heart conditions.
  \item \relax All of our patients are in the emergency rooms.
  \item \relax Patients who are mentally unwell.
  \item \relax Pediatrics.
  \end{enumerate}
  \textbf{Duration of the Study}

The study will take place over the course of six months (i.e. October 2018 to March 2019).
    
\section{RESULTS AND DISCUSSION}
Patients diagnosed with any type of coronary artery disease other than those listed above are included in the study. The study focused on patient data such as age, sex, previous and present medical profiles, and various therapy classes. The information came from the medical records of patients who had a profile. Approximately 5275 patients visited the hospital throughout the study period. Because 500 of them were confirmed to have coronary artery disease, the prevalence of coronary artery disease was determined to be 9.478 percent. The inclusion and exclusion criteria in this study resulted in the selection of 100 patients.

Figure~\ref{f-f4e909288fba}  depicts the prevalence of coronary artery disease in the given population. In Table~\ref{tw-55cae7e9abbe}, the gender distribution of CAD patients was tabulated. Figure~\ref{f-277a40bac0ab} shows a column chart depicting the age distribution of cad patients. Table~\ref{tw-bcccd94d6d3e} lists the surgical procedures that were observed in the study population. Table~\ref{tw-13172128c0a9} shows a cross-tabulation of medical conditions and patient numbers. Figure~\ref{f-dadf99047afb} shows a bar chart depicting physician prescribing patterns. Table~\ref{tw-9415c1a01861} shows a cross-tabulation of prescribed medicines and the number of drugs administered.

Coronary artery disease can strike anyone at any age, however the risk of developing the condition rises with age. The majority of patients in this study are between the ages of 51 and 60, followed by those between the ages of 61 and 70. This is in line with a prior analysis on CAD drug utilisation review, which found that the most common age group with CAD was 40-60 years old.

The doctors' extensive diagnosis indicated that the individuals had a variety of clinical problems. Diabetis was found in 38 percent of patients, while metabolic acidosis was diagnosed in 1\% of patients. Obesity was found in nearly one percent of CVD patients. Three percent of patients had hyperthyroidism, three percent had renal diseases, one percent of patients had anaemia, and ten percent of patients had other diagnoses.

Coronary artery disease is more common in older people than in younger patients, as are related conditions such as diabetes, renal disorders, thyroid disorders, anaemia, asthma, COPD, and gastrointestinal disorders. Diabetes mellitus was the disease with the most related diseases reported in this investigation. Diabetes, anaemia, and asthma were the co-morbidities related with CAD, according to CAD prevalence and drug consumption patterns. Physicians prescribed a variety of pharmacological therapeutic medication groups. These medications have been classified and prescribed to patients in various groups. Antiplatelets were prescribed to the majority of patients (18.84\%), followed by cholesterol lowering medicines (14.65\%), anti-anginal medications (5.47\%), and anticoagulants (5.47\%). (5.47 percent ). Beta adreno receptor blockers (7.24 percent), ACE inhibitors (0.48 percent), Angiotensin-converting enzyme inhibitors (0.48 percent), calcium channel blockers (2.41 percent), and diuretics were all recommended to the patients (5.47 percent). Anti-ulcer medications were prescribed in 13.52 percent of the cases, whether the patients had ulcers or not. The most common lipid-lowering medication was rosuvastatin (53.84 percent), followed by atorvastatin (46.15 percent).
    
\section{CONCLUSION}
The majority of the participants in the research had coronary artery disease, according to the findings. This could be as a result of their eating habits, smoking, lack of exercise, and poor health hygiene. Because the prescribing pattern was sensible and followed established treatment guidelines, the treatment was effective, as evidenced by the patient's return to normal life. The majority of the patients were men. When compared to other cardiovascular medicines, statins and anti-atherogenic treatments are the most common. The anti-hypertensive group is dominated by beta blockers, ACE inhibitors, and diuretics. The study has some limitations, leading to the conclusion that it cannot be considered a standard study because it was conducted at a single tertiary level hospital and may not be comparable to data from other generalist institutions. The prescribing practise of calcium channel blockers and angiotensin receptor blockers should be modified by implementing educational interventions.

\textbf{Funding Support}

The authors declare that they have no funding support for this study.

\textbf{Conflict of Interest}

The authors declare that there is no conflict of interest.

\textbf{Ethical Issues}

We obtained the informed consent from the patients enrolled.
    
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