Utilisation Patterns of Cardiovascular Medicines Among Outpatients at a Tertiary Cardiac Institute in Tanzania (2017-2022)

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Abstract
Background: Cardiovascular diseases are among the leading causes of morbidity and mortality worldwide. Routine quantification of cardiovascular medicine utilisation is essential for stewardship, formulary decision-making and procurement planning. Objective: To describe outpatient utilisation of cardiovascular medicines at the Jakaya Kikwete Cardiac Institute (JKCI) using ATC/DDD methodology. Methods: This was a retrospective longitudinal analysis of outpatient prescriptions (2017/2018-2021/2022). Medicines were classified according to the ATC system and quantified as Defined Daily Doses (DDD) per 100 outpatient days. The analyses progressed hierarchically from ATC levels 1 to 5. DU metrics (DU50/DU90) were used to assess the concentration. Monthly utilisation was examined using Seasonal Trend decomposition using Loess (STL). Statistical analyses were performed using SPSS (version 26). Results: Across the study period, the cumulative utilisation of cardiovascular medicines totalled 360.55 DDD per 100 outpatient days. Annual intensity peaked in 2018/2019 (82.92 DDD per 100 outpatient-days), was the second-highest in 2020/2021 (82.39), and was lowest in 2017/2018 (55.68). At ATC level 5, amlodipine (C08CA01), candesartan (C09CA06) and clonidine (C02AC01) were the principal contributors. The DU50 segment comprised five molecules (amlodipine, candesartan, clonidine, furosemide, and atorvastatin), whereas DU90 ranked 18th, indicating concentrated utilisation within a small number of agents. The STL showed a gradual secular rise with no statistically significant month-specific seasonality. Conclusion: Outpatient cardiovascular medicine utilisation at JKCI was concentrated within a narrow set of anti-hypertensive agents, with a cumulative burden of 360.55 DDD per 100 outpatient-days and a fiscal-year peak in 2018/2019. Institutionalising routine outpatient DDD surveillance may support stewardship, rational prescribing, and more equitable access to high-impact cardiovascular medicines in Tanzania.

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