Low use of statins and other coronary secondary prevention therapies in primary and secondary care in India
Krishna K Sharma1, Rajeev Gupta2, Aachu Agrawal3, Sanjeeb Roy2, Atul Kasliwal2, Ajeet Bana2, Ravindra K Tongia2, Prakash C Deedwania4
1Department of Pharmacy, LBS College of Pharmacy, Jaipur, India; 2Departments of Medicine, Cardiology and Cardiac Surgery, Fortis Escorts Hospital, Jaipur, India; 3Department of Home Science, University of Rajasthan, Jaipur, India; 4Department of Cardiology, University of California San Francisco-VA Health System, Fresno, CA, USA
Objective: To 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.
Methods: Physicians practicing at tertiary hospitals and clinics at tertiary, secondary and primary levels were contacted. Prescriptions of CHD patients were audited and descriptive statistics reported.
Results: We 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.
Conclusions: There is suboptimal use of various evidence-based drugs (aspirin, beta blockers, ACE inhibitors, and statins) for secondary prevention of CHD in India.
Keywords: statins, coronary heart disease, aspirin, beta blockers, angiotensin-converting enzyme inhibitor
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