Pharmacological management of some cardiovascular disorders at Komfo Anokye Teaching Hospital

INTRODUCTION: A drift from agrarian to industrialized economies in Africa may have contributed to the rising incidence of cardiovascular diseases on the continent. This study aimed to assess the pharmacotherapy of cardiac arrhythmias of clinical relevance, coronary heart diseases and heart failure at Komfo Anokye Teaching Hospital; and how they conformed to local and international treatment guidelines for disease management. Drug related issues encountered and International Normalized Ratio monitoring for warfarin recipients were also evaluated. METHOD: A data collecting form was used to extract information from 248 patients presenting with confirmed diagnosis of heart failure, arrhythmias and coronary heart disease at the cardiac clinic of Komfo Anokye Teaching Hospital from January-June 2015. Data obtained included demographic characteristics of the patients, laboratory investigations, treatment, risk factors, adverse effects to patient’s medication and International Normalized Ratio records for warfarin therapy RESULTS: Females were 56.4% of study participants. The median age of participants was 62 years. Median age for females was lower than males, 59 and 64 years respectively. Heart failure was present in 85% of the patients (n=210), 17% of the patients (n=42) were diagnosed with arrhythmias and 15% (n=37), coronary heart disease. There was significant association between advancing age and cardiovascular diseases per gender (χ2=8.776). Associations of diabetes mellitus with coronary heart disease and cardiomyopathy with heart failure were also statistically significant; OR=5.53; 95% CI of 2.53-12.09 and OR=2.27; 95% CI of 1.21-4.27 respectively. About 90% of heart failure patients received loop diuretics exclusively or in addition to thiazide/thiazide-like diuretics. Majority of those patients (over 80%) also received angiotensin converting enzyme inhibitors/ angiotensin receptor blockers whereas 62.7%, 56.5%, 50% and 32% received beta-blockers, aldosterone antagonists, antiplatelets/anticoagulants and cardiac glycosides respectively. Widely prescribed drugs used for coronary heart disease were beta-blockers (73%), antiplatelet (75.7%), hydroxy-3-methylglutaryl coenzyme A reductase inhibitors - statin (70.3%) and angiotensin converting enzyme inhibitor/angiotensin receptor blocker (70.2%). Cardiac arrhythmias (predominantly atrial fibrillation) were managed with beta-blockers (71.5%) and antiplatelets/ anticoagulants (70%). On the whole, assessment of pharmacotherapy conformity to selected local and international guidelines yielded 100%. Out of 19 suspected adverse reactions, gastric pain and cough formed the mainstream of reported cases. Two possible adverse drug reactions were likely to have resulted from drug-drug interactions. Most existing patients (61%) on warfarin therapy were within therapeutic International Normalized Ratio. About 31% and 8% had International Normalized Ratio values above and below recommended ranges respectively. CONCLUSION: Cardiomyopathy and diabetes mellitus were statistically associated with cardiovascular diseases. The diseases assessed were managed with appropriate pharmacological agents and all therapeutic regimen conformed to local or international guidelines. Most reported adverse effects were related to the gastrointestinal, central nervous and respiratory systems and two of drug-drug interactions observed may have resulted in adverse effects. Majority of patients on warfarin were adequately monitored and laboratory investigations fell within acceptable International Normalized Ratio.

Source: KNUST