Pharmacoepidemiology of Cardiovascular Medicines Used Among Inpatients at a Tertiary Care Hospital in Tanzania, 2016-2022

Authors:
Preprint
Publisher website
Google Scholar
Abstract
Introduction: Cardiovascular diseases remain a major cause of morbidity and mortality in sub-Saharan Africa; however, little is known about inpatient cardiovascular medicine utilisation in Tanzania. This study quantified cardiovascular medicine utilisation patterns at a national cardiac referral centre using the standardised WHO ATC/DDD methodology. Methods: A retrospective longitudinal pharmacoepidemiological study was conducted using inpatient prescription data from the Jakaya Kikwete Cardiac Institute (JKCI) for the fiscal years 2016/2017 to 2021/2022. Non-medicinal items and topical formulations were excluded from the analyses. Utilisation was expressed as Defined Daily Doses (DDD) per 100 bed-days using the WHO ATC/DDD methodology. Descriptive statistics and non-parametric tests were performed using SPSS version 26. Results: Of the 290,591 prescription records screened, 224,290 were eligible following the exclusion of 64,781 non-medicinal items and 1,520 topical agents. Cardiovascular medicines (ATC class C) accounted for 99,634 (44.4%) of all prescriptions, followed by alimentary tract and metabolism agents (18.1%). The prescribing volumes increased annually and peaked in 2021/2022. Furosemide (C03CA01), spironolactone (C03DA01) and paracetamol (N02BE01) were the three most frequently prescribed medicines. The 12 most commonly used medicines represented approximately half of all the prescriptions. Conclusion: Cardiovascular medicines accounted for nearly half of all inpatient prescriptions, reflecting the substantial clinical demand and disease burden associated with cardiovascular conditions. Utilisation was dominated by loop and potassium-sparing diuretics, highlighting their central role in inpatient cardiac care. Routine surveillance using ATC/DDD metrics should be institutionalised to guide procurement, prescribing audits, and patient safety monitoring. Trial registration number Not applicable. What is already known on this topic: The incidence of cardiovascular diseases is increasing globally, with increasing medicine use in both high-and low-income settings. Evidence of inpatient cardiovascular medicine consumption in sub-Saharan Africa is limited to a few studies. Previous pharmacoepidemiological studies from SSA have mainly focused on antibiotics rather than medicines for chronic noncommunicable diseases. What this study adds”: This is the first longitudinal analysis of inpatient cardiovascular medicine use in Tanzania based on ATC/DDD. Nearly half of all inpatient prescriptions at the national cardiac referral centre were cardiovascular agents, predominantly diuretics. These findings establish a baseline for stewardship, informed procurement decisions, and future national monitoring efforts.

This publication has 19 references indexed in Scilit: