Integrated Analysis of Prescription Rationality, Drug-Related Problems, and Medication Adherence in Cardiovascular Patients

Abstract

Background: Cardiovascular diseases persist as a major global health burden, driven by modifiable risk factors notably hypertension, diabetes, smoking, obesity, and poor dietary patterns that promote progressive atherosclerosis, compromise coronary perfusion, and ultimately result in life-threatening ischemic complications. Objective: Our study was conceptualized to assess the prescribing practice in cardiovascular patients using WHO prescribing indicators, evaluate medication adherence, and examine the association between polypharmacy and other relevant drug-related problems. Methodology: An interventional study was conducted for 6 months among cardiovascular inpatients in a tertiary care research centre, South India, after procuring ethical clearance. A cohort of 150 participants were selected. Rational drug use was evaluated by analysing the prescription using WHO core indicators. Patient prescription including minimum of 2 medications were included in this study, and the prescriptions were analysed for drug-related problems through secondary resources like IBM Micromedex and LEXICOMP. They were assessed for medication adherence using a structured questionnaire, and the adherence pattern was analysed using regression analysis. Chi-square test was used to interpret Categorical data, while quantitative variables were analysed using paired t-tests. Results: The prevalence of cardiovascular disease was more evident in males (64.67%) than in females (35.33%), with the highest frequency observed in the 41–60 age group. Overall, the prescribing pattern in this cardiovascular patient population was irrational, as reflected by excessive polypharmacy (7.85 drugs per encounter), very low generic use (12.99%), over prescription of antibiotics (44.66%), and injections (80%), and suboptimal adherence to the Essential Medicines List (85.28%), all of which fall far outside WHO- recommended standards. Polypharmacy was identified among 78% of patients and has significantly coincided with an increased incidence of drug-related problems (p = 0.05), indicating a statistically significant relationship. Medication adherence improved significantly after patient counselling, with the mean and standard deviation adherence score (before=39.01 ± 3.54, after=40.66 ± 3.59) improving from 7.12 to 19.19. Conclusion: The study highlights concerning prescribing patterns in cardiovascular inpatients, including a high average number of drugs per encounter and low generic prescribing. A significant association was observed between polypharmacy and the proportion of drug-related problems, underscoring the need for vigilant prescription monitoring. Targeted patient counselling markedly improved medication adherence, emphasizing the value of pharmacist-led interventions in optimizing cardiovascular care.