Biomedical and Clinical Sciences, Clinical Sciences, Heart Disease, Heart Disease - Coronary Heart Disease, Clinical Research, Cardiovascular, Health Services, Evaluation of treatments and therapeutic interventions, 6.1 Pharmaceuticals, Good Health and Well Being, Adrenergic beta-Antagonists, Adult, Aged, Angiotensin-Converting Enzyme Inhibitors, Aspirin, Coronary Disease, Drug Prescriptions, Drug Therapy, Combination, Drug Utilization, Evidence-Based Medicine, Female, Guideline Adherence, Humans, Hydroxymethylglutaryl-CoA Reductase Inhibitors, India, Male, Middle Aged, Platelet Aggregation Inhibitors, Practice Guidelines as Topic, Practice Patterns, Physicians', Primary Health Care, Secondary Prevention, statins, coronary heart disease, aspirin, beta blockers, angiotensin-converting enzyme inhibitor, Cardiovascular System & Hematology, Cardiovascular medicine and haematology, and Clinical sciences
ObjectiveTo determine the frequency of use of pharmacotherapy with aspirin, beta blocker, statin, and angiotensin-converting enzyme (ACE) inhibitor in patients with stable coronary heart disease (CHD) among physicians at different levels of health care in Rajasthan state, India.MethodsPhysicians practicing at tertiary hospitals and clinics at tertiary, secondary and primary levels were contacted. Prescriptions of CHD patients were audited and descriptive statistics reported.ResultsWe evaluated 2,993 prescriptions (tertiary hospital discharge 711, tertiary 688, secondary 1,306, and primary 288). Use of aspirin was in 2,713 (91%) of prescriptions, beta blockers 2,057 (69%), ACE inhibitors or angiotensin receptor blockers (ARBs) 2,471 (82%), and statins 2,059 (69%). Any one of these drugs was prescribed in 2,991 (100%), any two in 2,880 (96%), any three in 1,740 (58%), and all four in 1,062 (35.5%) (P < 0.001). As compared to tertiary hospital, prescriptions at tertiary, secondary, and primary levels were lower: aspirin (96% vs 95%, 91%, 67%), beta blockers (80% vs 62%, 66%, 70%), statins (87% vs 82%, 62%, 21%): two drugs (98% vs 96%, 98%, 85%), three drugs (75% vs 58%, 55%, 28%), or four drugs (54% vs 44%, 28%, 7%) (P < 0.01). Use of ACE inhibitors/ARBs was similar while nitrates (43% vs 23%, 43%, 70%), dihydropyridine calcium channel blockers (12% vs 15%, 30%, 47%), and multivitamins (6% vs 26%, 37%, 47%) use was more in secondary and primary care.ConclusionsThere is suboptimal use of various evidence-based drugs (aspirin, beta blockers, ACE inhibitors, and statins) for secondary prevention of CHD in India.