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Title: Evaluation of Pharmacotherapy of Selected Heart Diseases for Potential Drug-Drug Interactions at Tertiary Care Hospitals of Peshawar, Pakistan
Authors: Haq, Inam ul
Keywords: Biological & Medical Sciences
Issue Date: 2020
Publisher: University of Peshawar, Peshawar.
Abstract: Hospitalized patients with heart diseases are often administered a number of concomitant drugs in order to achieve maximum therapeutic benefit. However, the concomitant use of multiple drugs increases the risk of drug-drug interactions (DDIs) and their associated adverse outcomes. Additionally, drugs used for comorbidities further add to the complexity of pharmacotherapy and the risk of DDIs. Therefore, studies are required to explore these issues in patients with heart diseases in order to promote drug safety. The present study aimed to identify the prevalence, nature, levels, and predictors of potential drug-drug interactions (pDDIs) among hospitalized patients with five most frequent heart diseases i.e., coronary artery disease (CAD), acute coronary syndrome (ACS), myocardial infarction (MI), congestive cardiac failure (CCF), and left ventricular failure (LVF). This study was conducted in cardiology wards of three major tertiary care hospitals of Peshawar, Khyber Pakhtunkhwa, Pakistan. Medical records of 2000 adult patients were included (n = 400 per disease). Micromedex Drug-Reax® was used for the identification of pDDIs. Odds ratios were calculated for various predictors using the binary logistic regression in order to quantify the risk of association. The overall prevalence of pDDIs was 95.5% in CAD, 98.3% in ACS, 96.7% in MI, 96.3% in CCF, and 96% in LVF. The prevalence of majorand moderate-pDDIs were 91.5% and 90.5% in CAD, 96.7% and 94.2% in ACS, 76.3% and 71.5% in MI, 88.2% and 92.5% in CCF, and 90.5% and 90.7% in LVF, respectively. Multivariate logistic regression analysis in CAD revealed a significant association of >5 pDDIs and >3 major-pDDIs with increasing number of prescribed drugs (p<0.001). In ACS, a significantly higher risk of >6 pDDIs and >4 major-pDDIs was observed with ≥9 prescribed drugs (p<0.001). In MI patients, the risk of >6 pDDIs was significantly xvii associated with 8-10 (p<0.001), 11-13 (p=0.001) and >13 prescribed drugs (p<0.001). Similarly, the risk of >4 major-pDDIs was significantly higher in patients with a hospital stay of 3-4 days (p=0.03) and >13 prescribed drugs (p<0.001). In patients with CCF, a significant association between >4 pDDIs was observed in patients taking 7-10 (p=0.001), 11-14 (p<0.001) and >14 prescribed drugs (p<0.001). Whereas, the association of >3 major-pDDIs was significantly higher in patients prescribed 7-10 (p=0.01), 11-14 (p=0.001) and >14 (p<0.001) drugs. The risk of >6 pDDIs was significantly higher with age of >70 years (p=0.009) and increasing number of prescribed medicines (p<0.001) in LVF. While, exposure to >4 major-pDDIs was significantly higher for male patients (p=0.007); and 9-12 (p=0.004) and >12 (p<0.001) prescribed drugs. Aspirin-clopidogrel, clopidogrel-enoxaparin, enoxaparin-streptokinase, furosemide-ramipril, atorvastatinclopidogrel, bisoprolol-insulin, digoxin-spironolactone and albuterol-furosemide were the most frequent drug interacting combinations, which were associated with signs/symptoms of bleeding, elevated blood pressure, deteriorated renal function, impaired clinical response, chest pain, orthopnea, edema, and electrolyte abnormalities. In conclusions, a high prevalence of pDDIs was observed in patients with CAD, ACS, MI, CCF and LVF. Of which, major- and moderate-severity pDDIs were most frequent. Patients with extended hospital stay and increased number of prescribed drugs were at higher risk of pDDIs. The findings of this study necessitate vigilant assessment of hospitalized patients with various heart diseases regarding the identification, prevention and management of pDDIs and their associated adverse outcomes.
Gov't Doc #: 20220
Appears in Collections:PhD Thesis of All Public / Private Sector Universities / DAIs.

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