Evaluation of Drug Utilization Patterns and Drug-Related Problems in Myocardial Infarction Management at a Tertiary Care Hospital: A Cross-Sectional Observational Study

safa gul

doi:10.62497/irabcs.216

Authors

safa gul Northwest Institute of Health Science Author

DOI:

https://doi.org/10.62497/irabcs.216

Keywords:

Pharmacotherapy, Myocardial infarction, Drug–drug interactions, Adverse drug reactions, Rational prescribing

Abstract

Background: Myocardial infarction (MI) remains a major cause of morbidity and mortality worldwide, particularly in resource-limited settings. Appropriate pharmacotherapy is essential for optimizing patient outcomes; however, drug-related problems, potential drug–drug interactions, and cost-related prescribing issues may affect the quality and safety of MI management. Evaluating drug utilization patterns in hospitalized MI patients may help identify opportunities for improving prescribing practices.

Objective: To evaluate drug utilization patterns and identify drug-related problems, potential drug–drug interactions, untreated conditions, and cost-related prescribing issues among hospitalized patients with myocardial infarction.

Methods: A prospective descriptive observational case series was conducted in the cardiac ward and coronary care unit of Ayub Teaching Hospital, Abbottabad, Pakistan, from December 2019 to March 2020. Fifteen hospitalized patients diagnosed with myocardial infarction were included during the study period as part of an exploratory pilot assessment. Data were collected prospectively using a structured Subjective, Objective, Assessment, and Plan (SOAP)-based proforma. Drug-related problems and potential drug–drug interactions were identified using standard clinical references and categorized descriptively. Data were analyzed using Microsoft Excel and presented as frequencies and percentages.

Results: Among the 15 patients included, 53.3% were male and 46.7% were female, with most patients (66.7%) aged 56–65 years. ST-elevation myocardial infarction was more common (73.3%) than non-ST-elevation myocardial infarction (26.7%). Potential drug–drug interactions were identified in all evaluated prescriptions, most commonly involving antiplatelet and anticoagulant combinations. Commonly observed drug-related problems included cost-related prescribing issues (86.7%), inappropriate dosing frequency (60.0%), inappropriate dosing (53.3%), and untreated clinical conditions (46.7%).

Conclusion: This study identified a considerable burden of drug-related problems and potential drug–drug interactions among hospitalized patients with myocardial infarction. The findings highlight the importance of regular prescription review, adherence to evidence-based prescribing practices, and multidisciplinary medication monitoring to support rational pharmacotherapy and patient safety.

Downloads

Download data is not yet available.

References

Mechanic OJ, Gavin M, Grossman SA. Acute myocardial infarction. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan– [cited 2026 May 2]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK459269/

Salari N, Morddarvanjoghi F, Abdolmaleki A, Rasoulpoor S, Khaleghi AA, Hezarkhani LA, Shohaimi S, Mohammadi M. The global prevalence of myocardial infarction: a systematic review and meta-analysis. BMC Cardiovasc Disord. 2023 Apr 22;23(1):206. doi:10.1186/s12872-023-03231-w. PMID: 37087452; PMCID: PMC10122825.

Sachdeva P, Kaur K, Fatima S, Mahak F, Noman M, Siddenthi SM, Surksha MA, Munir M, Fatima F, Sultana SS, Varrassi G, Khatri M, Kumar S, Elder M, Mohamad T. Advancements in myocardial infarction management: exploring novel approaches and strategies. Cureus. 2023 Sep 19;15(9):e45578. doi:10.7759/cureus.45578. PMID:

; PMCID: PMC10587445.

Saha T, Soliman-Aboumarie H. Review of current management of myocardial infarction. J Clin Med. 2025 Sep 4;14(17):6241. doi:10.3390/jcm14176241. PMID: 40944000; PMCID: PMC12429806.

Christian RP, Rana DA, Malhotra SD, Patel VJ. Evaluation of rationality in prescribing, adherence to treatment guidelines, and direct cost of treatment in intensive cardiac care unit: a prospective observational study. Indian J Crit Care Med. 2014 May;18(5):278284. doi:10.4103/0972-5229.132482. PMID: 24914255; PMCID: PMC4047688.

Anwar MF, Daud NAA, Hussain R. From prescribing indicators to rational drug use: a medication safety perspective. J Pharm Policy Pract. 2025 Aug 27;18(1):2544656. doi:10.1080/20523211.2025.2544656. PMID: 40896173; PMCID: PMC12392430.

Akbar Z, Rehman S, Khan A, Khan A, Atif M, Ahmad N. Potential drug-drug interactions in patients with cardiovascular diseases: findings from a prospective observational study. J Pharm Policy Pract. 2021 Jul 26;14(1):63. doi:10.1186/s40545021-00348-1. PMID: 34311787; PMCID: PMC8311960.

Patel S, Huang M, Miliara S. Understanding treatment adherence in chronic diseases: challenges, consequences, and strategies for improvement. J Clin Med. 2025 Aug 26;14(17):6034. doi:10.3390/jcm14176034. PMID: 40943792; PMCID:

PMC12429436.

Niriayo YL, Kifle R, Asgedom SW, Gidey K. Drug therapy problems among hospitalized patients with cardiovascular disease. BMC Cardiovasc Disord. 2024 Jan 15;24(1):50. doi:10.1186/s12872-024-03710-8. PMID: 38221638; PMCID: PMC10788969.

Shareef J, Sridhar SB, Hamouda SA, Ali A, Thomas AC. Prescribing practices, polypharmacy, and drug interaction risks in anticoagulant therapy: insights from a secondary care hospital. J Clin Med. 2026 Jan 19;15(2):800. doi:10.3390/jcm15020800.

PMID: 41598736; PMCID: PMC12842065.

Chikatipalli R, Kuttiappan A, Kumar S, R V, Kujur P, N A A, N R P, Chenchula S. Prescribing trends and rational drug use patterns in cardiovascular patients: a crosssectional observational study. Bioinformation. 2024 Nov 30;20(11):1582-1587. doi:10.6026/9732063002001582. PMID: 40162464; PMCID: PMC11953553.

Seid T, Abdela J, Dechasa M, Nigussie S. Drug therapy problems and associated factors among adult patients admitted to the surgical ward in a resource-limited setting. Front Pharmacol. 2025 Jul 4;16:1548105. doi:10.3389/fphar.2025.1548105. PMID: 40689210; PMCID: PMC12270887.

Murtaza G, Khan MY, Azhar S, Khan SA, Khan TM. Assessment of potential drugdrug interactions and its associated factors in hospitalized cardiac patients. Saudi Pharm J. 2016 Mar;24(2):220-225. doi:10.1016/j.jsps.2015.03.009. Epub 2015 Mar 20. PMID: 27013915; PMCID: PMC4792893.

Sajid N, Aziz A, Asif S, Ashraf S, Iqbal AA, Ali G, Amir M, Ikram J. Evaluation of cost-effective therapy by comparing brands of the same formulation in Pakistan. Curr Pharm Rev. [cited 2026 May 2]. doi:10.32350/cpr.vancour style.

González-Bueno J, Sevilla-Sánchez D, Puigoriol-Juvanteny E, Molist-Brunet N, Codina-Jané C, Espaulella-Panicot J. Factors associated with medication non-adherence among patients with multimorbidity and polypharmacy admitted to an intermediate care center. Int J Environ Res Public Health. 2021 Sep 12;18(18):9606. doi:10.3390/ijerph18189606. PMID: 34574530; PMCID: PMC8464705.

Charosaei F, Rostami S, Esmaeili M, Molavynejad S, Vanaki Z. Challenges in implementation of patient-centred care in cardiac care unit: a qualitative study. Nurs Open. 2023 Feb;10(2):838-849. doi:10.1002/nop2.1352. Epub 2022 Sep 4. PMID: 36057965; PMCID: PMC9834141.

Ewunetu M, Temesgen W, Zewdu D, Andargie A, Kebede M, Lidetu T. Patients’ perception of patient-centered care and associated factors among patients admitted in private and public hospitals: a comparative cross-sectional study. Patient Prefer Adherence. 2023 Apr 17;17:1035-1047. doi:10.2147/PPA.S402262. PMID: 37090181; PMCID: PMC10120812.

Khan A, Al-Subari AMA, Mushtaq S, Hameed K, Abbas S, Iqbal M, Dong Y, Feng W, Fang Y. Evaluating rational drug use in developing countries: a cross-sectional analysis of prescribing patterns against WHO indicators in Pakistan and Yemen. Pharmacol Res Perspect. 2025 Dec;13(6):e70174. doi:10.1002/prp2.70174. PMID: 41258679; PMCID: PMC12628343.

Khobrani M, Alshahrani SM. Clinical pharmacist-led interventions and their impact on outcomes in patients with bipolar I disorder: a systematic review and meta-analysis. Front Med (Lausanne). 2025 Dec 12;12:1725491. doi:10.3389/fmed.2025.1725491. PMID: 41458502; PMCID: PMC12741269.

Aksoy M, İlerler EE, Karakurt S, Sancar M. Clinical pharmacist-led medication review in patients with sepsis and septic shock in the intensive care unit: a non-randomized controlled study. BMC Health Serv Res. 2025 Oct 20;25(1):1375. doi:10.1186/s12913025-13570-3.