Drug therapy problems related to cardiovascular agents and associated factors among heart failure patients: a prospective observational study of a tertiary inpatient setting in Uganda

Abstract

Background: Heart failure (HF) is a clinical syndrome that is treated with multiple medications, putting patients at risk of drug therapy problems (DTPs). DTPs are a great concern in health care due to their significant impact on morbidity, mortality, and higher costs associated with health care. Aims: This study aimed to assess the prevalence and factors associated with DTPs related to cardiovascular agents among HF patients hospitalized at the Mbarara Regional Referral Hospital. Methods: A prospective observational study was conducted among hospitalized HF patients from November 2021 to January 2022. A total of 118 patients diagnosed with HF were recruited. Patient file reviews and interviewer-administered questionnaires were used for data collection. Univariate and multivariate logistic regressions were employed to determine factors associated with the DTPs. Result: A total of 118 HF patients with a median age of 43 years were included in this study. Among them, 57 participants experienced a total of 81 DTPs with a prevalence of 48.3%. “Dosage too high” was the most common DTP (23, 28.3%) followed by “needs additional drug therapy” (22, 27.2%). Hospitalized HF patients aged 60 years and above (adjusted odds ratio [AOR]: 4.1; 95% confidence interval [CI]: [1.5 – 10.3]; P = 0.012) and taking more than five medications during their hospital stay (AOR: 2.92; 95% CI: [1.5 – 7.6]; P = 0.029) were significantly associated with experiencing at least one DTP. Conclusion: Almost half of the hospitalized HF patients experienced at least one DTP during their hospital stay. “Dosage too high” and “needs additional drug therapy” were the most common DTPs. Hospitalized HF patients with poly-pharmacy (taking more than five cardiovascular agents) and aged above 60 were more likely to have DTPs. It is noted that patient groups who are at risk require follow-ups to improve the treatment outcome, and incorporation of clinical pharmacy service could be part of the solution. Relevance for Patients: This study identifies the factors associated with the development of DTP to facilitate the development and implementation of prevention strategies for the commonly identified DTPs.