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196 Shegena et al. | Journal of Clinical and Translational Research 2024; 10(3): 191-200
Table 3. Types of DTPs and their causes among hospitalized HF the appropriate use of medication by adhering to national
patients at the MRRH from November 2021 to January 2022 and evidence-based guidelines to optimize patient outcomes.
Type of DTP Cause of DTP n (%) Adverse drug reactions, another DTP, were reported in 59.3%
Needs additional drug Untreated condition 15 (18.5) of the same population [37].
therapy Preventive drug needed 2 (2.5) The identification of associated factors for DTPs related to
Synergistic therapy 5 (6.2) cardiovascular agents helps to identify the most susceptible
Unnecessary drug No valid medical indication 5 (6.2) patients who require close monitoring of drug therapy [15].
therapy Duplicate therapy 9 (11.1) Multivariate logistic regression revealed that elderly patients
To treat avoidable ADR 2 (2.5) >60 years old were four times more likely to be associated with
Dosage too low Ineffective dose 3 (3.7) DTPs related to cardiovascular agents compared to the pediatrics
Dosing too infrequent 5 (6.2) group (AOR: 4.1; 95% CI: [1.5 – 10.3]; P = 0.012). This finding
Short duration of therapy 1 (1.2) is in agreement with several studies that revealed that elderly
Ineffective drug More effective drug available 11 (13.6) patients were more susceptible to DTPs compared to younger
therapy adults [28,33,38]. This may be explained by the fact that there is
Dosage too high Dose too high 19 (23.5) a difference in pharmacokinetics and pharmacodynamics among
Drug interaction 3 (3.7) elderly and pediatric populations [16]. Many medications act
No dose adjustment for renal impairment 1 (1.2) differently in older and younger people due to the physiological
Abbreviations: HF: Heart failure; MRRH: Mbarara Regional Referral Hospital; and pathological changes that accompany aging. According
DTPs: Drug therapy problems; ADR: Adverse drug reaction. to the American Geriatrics Society (AGS), many medications
have different efficacy and safety profiles in younger and older
the associated problems. In addition, this study also warrants age groups [33]. In addition, studies have demonstrated that
further research among CVD patients on the study site. elderly patients have comorbidities and usually take complex
Multiple studies conducted among patients on cardiovascular medication regimens, increasing the risk of DTPs. From the
agents revealed DTPs related to cardiovascular agents. current findings, special attention is warranted for these patient
A study conducted among Taiwanese HF patients [32] and in groups by optimizing dosage regimens and following up during
Barcelona [31] identified that the principal drugs associated medication therapy. This study has revealed that almost 40%
with DTPs were cardiovascular agents, such as angiotensin- of pediatric HF patients had at least one DTP during their
converting enzyme/angiotensin II receptor blockers (ACEI/ hospitalization. Similarly, a multi-center study conducted in
ARBs), diuretics, spironolactone, and β-blockers. four French-speaking countries among pediatric patients in a
The most common type of DTP related to cardiovascular cardiac and intensive care unit revealed that a significant number
agents identified in this study was “dosage too high” (28.3%). of DTPs were recorded during their follow-up [39]. Therefore,
The common cause for “dosage too high” was the prescribed there is a need for further studies to be conducted among the
medication dose being too high for the hospitalized patients. This pediatric population to mitigate the problem.
might be attributed to a lack of compliance with the standard and In addition, the present study reported that patients who
updated guidelines while selecting and dosing medications for were taking more than 5 medications during their hospital stay
HF patients. Moreover, it could be due to failure to assess the were three times more likely to experience DTPs related to
patient’s organ functions (e.g., renal and hepatic functions), the cardiovascular agents than those who were taking <5 medications
patient’s age and weight, and possible DDIs. On the contrary, during their hospital stay (AOR: 2.92; 95% CI: [1.5 – 7.6];
studies [15,28,33] had reported that “dosage too low” (22 – 27.8%) P = 0.029). This finding is consistent with previously reported
was one of the common DTPs observed among patients who studies involving hospitalized HF patients [15,22,28,33,35,40].
were using cardiovascular agents, whereas our finding reported Poly-pharmacy has been a significant challenge among CVD
that only 11.1% of DTPs related to cardiovascular agents were patients, but it can be controlled by simplifying the medication
“dosage too low.” Therefore, efforts should focus on minimizing regimen by eliminating pharmacologic duplication and regularly
drug dosing problems in HF patients by adhering to standard reviewing the treatment regimen [40]. Studies have indicated
treatment guidelines and increasing the involvement of clinical that having clinical pharmacists in the multidisciplinary team
pharmacists in deciding the dosing of drugs, i.e., considering the in treating CVDs, including HF, would reduce DTPs, improve
age and clinical condition of the patient. medication adherence, and increase the treatment satisfaction of
The second most common DTP related to cardiovascular HF patients [15,40-42]. For this reason, the clinical pharmacists’
agents in this study was “needs additional drug therapy” intervention could help in addressing this problem and improve
(27.2%). This proportion is consistent with many studies the treatment outcome of HF patients.
involving CVD patients, i.e., 27.4 – 45.5% [15,26,28,33–36]. Our study had several limitations. The study was conducted
In the current study, the common cause for “needs additional in a hospital serving referred patients who have severe
drug therapy” was the presence of an untreated condition, illnesses and more comorbidity. Hence, the findings may not
leading patients to low quality of life, increased hospitalization, be representative of the general population. In addition, the
increased overall health-care cost, and death if undetected and DTPs assessed were limited in number and only limited to those
resolved early [28]. This emphasizes the importance of ensuring associated with cardiovascular agents.

DOI: https://doi.org/10.36922/jctr.23.00137