Systematic Review: Evaluation of Treatment in Cardiac Patients

Lia Susika and Diana Laila Ramatillah

Faculty Pharmacy, University 17 August 1945 Jakarta, Jl. Sunter Permai Raya, Jakarta 14350, Indonesia

Keywords: Heart Disease, Heart Medicine.

Abstract: Coronary heart disease is a form of cardiovascular disease, the number one cause of death in the world and a

degenerative disease linked to people's socio-economic lifestyle. It is caused by the narrowing of the coronary

arteries, usually referred to as atherosclerosis. The aim of this research was to evaluate treatments for heart

disease. The research method used was a PRISMA (Preferred Reporting Items for Systematic Review) level

systematic review, which was done by searching for published articles about the use of drugs for heart disease.

The literature search was conducted from June to September 2023 using Google Scholar, the National Library

of Medicine and Public Health Review. The most commonly used treatments for heart disease are antiplatelets

(clopidogrel, aspirin), anticoagulants (enoxaparin, warfarin, fondaparinux, UFH), and beta-blockers

(propranolol, bisoprolol, carvedilol), ARBs (candesartan, telmisartan and irbesartan), statins (atorvastatin),

nitrates (ISDN and nitroglycerin), CCBs (amlodipine) and diuretics (furosemide, spironolactone) and the least

used is Ace-i (captopril, imidapril and ramipril). Conclusions from a review of the literature on the treatment

of heart disease are important to ensure appropriate and effective treatment.

1 INTRODUCTION

Heart and blood vessel disease (cardiovascular

disease) is a major health problem in developed and

developing countries. Heart disease occurs when the

cardiac output is insufficient to provide the body with

the oxygen it needs (Elly, Bayu and Nurdiana, 2019).

Cardiovascular disease (CVD) remains a global

threat and is the leading cause of death worldwide.

According to the World Health Organization (WHO),

more than 17 million people worldwide die from

heart and blood vessel diseases.

The medicines that are commonly used to treat the

heart depend on the type of heart disease. Several

classes of drugs that are commonly used to treat heart

disease include Antiplatelets, Anticoagulants,

Betablockers, ARBs, Statins, Nitrates, CCBs and

Diuretics.

Based on 2018 Basic Health Research (Riskesdas)

data, the incidence of 52 heart and blood vessel

diseases is increasing year by year. At least 15 out of

every 1000 people, or about 2,784,064 people in

Indonesia, suffer from heart disease (Ministry of

Health, 2019).

The treatment of heart disease is not only about

reducing or eliminating symptoms, but most

importantly about preserving heart function to

prolong life. In addition to heart disease, patients also

have co-morbidities that require different types of

drugs in the therapy given. Therefore, the choice of

the type of drug will largely determine the quality of

drug use in the selection of therapy.

2 RESEARCH METHODS

The research method used is a systematic review,

which searches for published articles related to the

use of cardiac medications. The search strategy used

to obtain research articles used online database

facilities via the Google Scholar site, the National

Library of Medicine and Public Health Reviews using

the keywords "heart disease, heart medicine", with

the search years limited to 2017 to 2023. The author

used systematic review methods according to the

PRISMA (Preferred Reporting Items for Systematic

Review) stages, which include identification,

filtering, inclusion and eligibility of articles for

further analysis.

To record treatment, articles that met the inclusion

criteria were reviewed. Each risk factor found in the

published research report is recorded and presented

with a narrative explanation. Conclusions are drawn

based on treatment and drug data related to the use of

Susika, L. and Ramatillah, D.

Systematic Review: Evaluation of Treatment in Cardiac Patients.

DOI: 10.5220/0012642900003821

Paper published under CC license (CC BY-NC-ND 4.0)

In Proceedings of the 4th International Seminar and Call for Paper (ISCP UTA ’45 JAKARTA 2023), pages 251-256

ISBN: 978-989-758-691-0; ISSN: 2828-853X

251

cardiac medications. The literature search yielded

1670 articles from Public Health Reviews, National

Library of Medicine and Google Scholar data, there

were several that did not meet the inclusion criteria,

40 articles were excluded. There are still 20 articles

with full manuscripts.

Figure 1: Article collection using the PRISMA method.

3 RESULTS PERVIOUS

RESEARCH

Table 1: Pervious research.

No. Author Title Conclusion

1 Yuni Andriani, Robiyanto,

Nurmainah (2017)

Profile of Patients Using Inpatient Coronary

Heart Medicine at Sultan Syarif Mohammad

Alkadrie Regional Hospital Pontianak, 2017

The types of drugs used in CHD patients were

nitrates in 37 patients, antiplatelets in 34 patients,

anticoagulants in 30 patients, statins in 23 patients,

and β-

lockers in 15 patients.

2 Tri Wulandari, Nurmainah,

Robiyanto, (2017)

Description of Drug Use in Inpatient Congestive

Heart Failure Patients at Sultan Syarif Mohamad

Alkadrie Hospital Pontianak, 2017

that the most frequently used drugs were diuretic

drugs 62.50%, ARB 23.75%, ACE inhibitors

7.50%, and beta blockers 6.25%.

3 Dwi Ulfa Rahmawati,

Nurul Mutmainah (2018)

Study of Potential Drug Interactions in Inpatient

Coronary Heart Disease Patients at Moewardi

Regional Hospital, 2018

Management of coronary heart disease requires

several medications such as (beta blockers, nitrates,

CCBs, ARBs, ACE-Inhibitors); anti- platelets

(Aspirin, Ticagrelor, Clopidogrel); anti- coagulants

(Enoxaparin, Warfarin, Fondaparinux, UFH) and

statin drugs as lipid controllers.

Filter

Article n = 80

The articles were identified

by searching the National

library of Medicine database

n = 400

The articles were identified

by searching Public Health

Reviews database

n = 250

The articles were

identified by searching

the Google Scholar

database

n = 1020

Filtering

Identification

Articles that fall under the

criteria

n = 20

Eligibility

Complete articles or

journals were excluded

because they did not use

English and articles

published before 2017,

articles did not have a clear

publication and the result

were non- health impacts.

Full- text articles Assessed

For eligibility

n = 40

Inclusion

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Table 1: Pervious research (cont.).

No. Author Title Conclusion

4 Anisa, Widya Fikma,

(2019)

Evaluation of Medication Use in Congestive Heart

Failure Patients at the Cardiac Clinic of RSUP DR.

M. Djamil Padang.

The results of research on the use of the most

widely used drugs are

Bisoprolol (26.1%),

Furosemide (25.5%), and

Spironolactone (20.9%).

5 Indah Setyaningsi, Rinto

Susilo, Khofifah, (vol.1

No. 2, January 2019)

Description of Potential Drug Interactions in

Prescriptions for Cardiovascular Patients at the

Internal Medicine Clinic at Gunung Jati Regional

Hospital, Cirebon 2018

The research results show that the most frequently

prescribed cardiovascular drug is amlodipine,

namely 63 sheets, the least is ACEI inhibitor drugs

such as captopril, imidapril and ramipril, each of

which only has 1 sheet.

6 Tatang Tajudin, Velya

Faradiba, Ikhwan Dwi

Wahyu Nugroho,

(2019)

Combination Analysis of Drug Use in Coronary

Heart Disease Patients with Concomitant Diseases

at X Hospital Cilacap, 2019

Cardiovascular system drugs that are often given for

coronary heart cases are CCB (Amlodipine),

antiplatelet (Aspirin, Clopidogrel), Beta blockers

(Bisoprolol, ARB (Irbesartan, Candesartan), Statins

(simvastatin, Atorvastatin) and at least ACE-i (

Captopril, Ramipril)

7 Wirtanto, Ardy Putra,

(2019)

Application of the European Society of Cardiology

Suspension Failure Management Guidelines for

Heart Failure Patients for the Period January 2015 –

December 2018 at RSUP. Adam Malik Medan.

Recommended drug use based on indications is

ACE-i/ARB (89.1%), beta-blockers (83.4%), and

diuretics (93.7%)

8 Fitriadi. Ab, Muh.

Shawwal (2020)

Profile of Cardiovascular Drug Use in Makassar

Inpatient Health Centers for the Period January

2019 - June 2019

There were 5 types of medication given to each

patient with different doses, it was found that

Clopidogrel, Simvastatin, Bisoprolol, Valsartan,

Aspilet, Candesartan, and Nitrokaf.

9 Ria Selrina, Endang

Susilowati, (2020)

Coronary Heart Disease Prescribing Patterns at the

Outpatient Clinic of Hermina Tangkuban Prahu

Hospital, Malang, February 2020.

The results of the study showed that the drug classes

used in CHD therapy were antiplatelet 37.5%

(Clopidogrel, acetosal, cilostazol, tricagelor), Statin

29.8% (simvastatin, atorvastatin, rovastatin), nitrate

20.5% (ISDN, and Nitroglycerin ), beta blockers

4.7% (Propranolol, Bisoprolol and carvedilol), ARB

4.2% (Candesartan, telmisartan and irbesartan),

ACE-I 0.7% (Imidapril and perindopril) and CCB

0.5% (Amlodipine ).

10 Rini Dwi Lestari,

Rasmala Dewi, Mukhlis

Sanuddin,

(2020)

Evaluation of Medication Use in Coronary Heart

Disease Patients in the Inpatient Installation of

Raden Mattaher Regional Hospital Jambi,2020

The results of the research show that the type of

drug most widely used for coronary heart patients is

the antiplatelet group (100%),

beta blockers(100%, statins (100 %),

nitrate (95.2 %),

ACE inhibitors (11.9 %).

11 Risma Siagian, (2020) Description of Drug Prescribing Profile in

Outpatient Heart Disease Patients at Rs.

Bhayangkara Medan, 2020

The results of the study showed that the highest

types of drugs used by heart disease sufferers were

Bisoprolol at 40%, Valsartan at 28%, Isosorbide

Dinitrate and Nitroglycerin at 3%, Warfarin, digoxin

and Amlodipine at 3%, and Candesartan at 1%.

11 Risma Siagian, (2020) Description of Drug Prescribing Profile in

Outpatient Heart Disease Patients at Rs.

Bhayangkara Medan, 2020

The results of the study showed that the highest

types of drugs used by heart disease sufferers were

Bisoprolol at 40%, Valsartan at 28%, Isosorbide

Dinitrate and Nitroglycerin at 3%, Warfarin, digoxin

and Amlodipine at 3%, and Candesartan at 1%.

12 Ayu Wulandari, (2021). Profile of Medication Use in Coronary Heart

Patients Inpatients at Wirabuana General Hospital,

Palu

Based on research results from an analysis of the

rationality of therapy for the use of the most widely

used coronary heart drug, namely amlodipine, at

25%.

13 Nur Hasanah, Fadly

Putajaya, Lela Kania,

Nur Wulan Adi Ismaya,

Nanda Nurul Aini,

(2021)

Description of Heart Disease Based on

Demographics and Medication Use in Patients with

Heart Disease at Home Hospital X in the city of

South Tangerang for the period 2015 to 2019

The research results show that the drugs that doctors

often prescribe are antiplatelets (Clopidogrel) and

Betablockers (Bisoprolol).

Systematic Review: Evaluation of Treatment in Cardiac Patients

253

Table 1: Pervious research (cont.).

No. Author Title Conclusion

14 Safitri, Puput Novita

(2021)

Heart Disease Drug Prescription Profile at the

Gama Sidoardjo Pharmacy December 2020 –

January

2021.

The most common types of drugs used by heart

disease sufferers are Spironolactone, Furosemide

and Candesartan.

15 Anisa Dwi Syafitri, (2022). Identification of Potential Drug Interactions in

Prescribing Coronary Heart Patients in the

Outpatient Installation of Airlangga University

Hospital, Surabaya, 2022.

The results of the study showed that the types of

drugs used were 316 antiplatelets and 288 beta

blockers.

16 Rakhmawati, Dian (2022) Profile of heart medication prescribing in

outpatient services at Hospital X Surabaya for the

period June-August 2021.

The research results show that the most widely

prescribed drug classes are:

Statin group (20.21%),

Antiplatelet group (16.53%),

Ca Antagonist group (12.25%), Angiotensin II

Receptor Antagonist group (10.94%) and

Betablocker group (10.70%).

17 Muhammad Tahir,(2022) Profile of Heart Medication Use in Outpatients at

Stella Maris Hospital Makasar

The research results show amlodipine drug 32.7%,

Bisoprolol 25.8%,

Candesartan 21.9%,

Furosemide 13.3%,

Simvastatin 6.87%,

and Nifedipine 1.25% and

the least used drug is Captopril 0.13%.

18 Moiwend, Richa Feronika,

(2022)

Overview of the Use of Heart Medicine in Heart

Disease Patients in the Out patient Installation of

Santa Maria General Hospital, Pemalang, 2022

The results of the study showed that the most

common drug use was bisoprolol. The drug group

that is often used to reduce and prevent myocardial

ischemia is the antiplatelet group (aspirin,

clopidorel), nitrates (Nitroglycerin), beta-blockers

(Bisoprolol), statins (atorvastatin).

19 Meidy, Arsa Nur (2022) Profile of Prescribing Heart Disease Medicines in

Outpatient Care at Wiyung Sejahtera Hospital,

Surabaya, 2021

The most common use of heart drug therapy is beta

blockers (Bisoprolol), Spironolactone (Diuretic),

Simvastatin (statin) and ARB (Candesartan.)

20 Wan Syurya Tri Dharma,

(2023)

Evaluating Drug Use For Coronary Heart Disease

Patients After Stent Insertion at RSPAD Gatot

Soebroto,2023

The results of the study showed that the type of drug

used was a combination of aspirin and clopidogrel

in 70 patients (83.34%).

4 DISCUSSION

The following are used to treat:

1. Antiplatelets (Clopidogrel, Aspirin), The

mechanism of action of Clopidogrel and Aspirin

is to prevent blood clots from forming in the

blood vessels because it can cause narrowing of

blood flow in the blood vessels, which can cause

the death of cells in the heart. (Nur Hasanah,

Fadly Putajaya, Lela Kania, Nur Wulan Adi

Ismaya, Nanda Nurul Aini, 2021).

2. Anticoagulants (Enoxaparin, Warfarin,

Fondaparinux, UFH), The mechanism of action

of anticoagulants works by preventing the

formation of networks between platelet cells. (Dr

Aditya Angela Adam, M. Biomed, 2022).

3. Betablockers (propranolol, bisoprolol,

carvedilol), the mechanism of action is different

from that of antihypertensive or antihypertensive

drugs and are used for secondary prevention.

(Nur Hasanah, Fadly Putajaya, Lela Kania, Nur

Wulan Adi Ismaya, Nanda Nurul Aini, 2021).

4. ARBs (candesartan, telmisartan and irbesartan),

The mechanism is angiotensin II receptor

antagonist. Their properties are similar to ACE

inhibitors, but this class of drugs does not inhibit

the breakdown of bradykinin and other kinins, so

it does not cause the persistent dry cough that

usually interferes with therapy with ACE

inhibitors. (Ria Selrina, Endang Susilowati,

2020).

5. Statins (atorvastatin), Treatment with statins

reduces the risk of primary or secondary

prevention. Atorvastatin as primary prevention of

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CHD in post-hypertension. In addition to

lowering cholesterol, statins have other

mechanisms (pleiotropic effects) that may play a

role, including anti-inflammatory and anti-

thrombotic effects. (Ria Selrina, Endang

Susilowati, 2020).

6. Nitrates (ISDN and nitroglycerine), are nitrates

that have a vasodilator effect. This medicine

works by dilating blood vessels and increasing

blood flow.

7. CCB (Amlodipine), Amlodipine works by

relaxing the walls of blood vessels, the effect of

which is to facilitate blood flow to the heart and

reduce heart pressure, in addition to reducing

symptoms of chest pain or angina pectoris in

coronary heart disease. (Ria Selrina, Endang

Susilowati, 2020).

8. Diuretics (furosemide, spironolactone), The

mechanism works by helping the kidneys to

release more salt and water from the blood

vessels into the urine.

9. Ace-i (Captopril, Imidapril and Ramipril),The

mechanisms can inhibit bradykinin degradation

and stimulate the synthesis of substances that can

cause vasodilation, increasing bradykinin

increases the blood pressure lowering effect of

ACE inhibitors.

5 CONCLUSION

Based on the results of a systematic review, the most

commonly used treatments in patients with heart

disease are antiplatelets (clopidogrel, aspirin),

anticoagulants (enoxaparin, warfarin, fondaparinux,

UFH), betablockers (propranolol, bisoprolol,

carvedilol), carvedilol), ARBs (candesartan,

telmisartan and irbesartan), statins (atorvastatin),

nitrates (ISDN and nitroglycerin), CCBs

(amlodipine) and diuretics (furosemide,

spironolactone) and the least used is Ace-i (captopril,

imidapril and ramipril).

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Anisa Dwi Syafitri, (2022). Identification of Potential Drug

Interactions in Prescribing Coronary Heart Patients in

the Outpatient Installation of Airlangga University

Hospital, Surabaya, 2022.

Ayu Wulandari, (2021). Profile of Medication Use in

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at the Internal Medicine Clinic at Gunung Jati Regional

Hospital, Cirebon 2018.

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Systematic Review: Evaluation of Treatment in Cardiac Patients

255

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of Drug Use in Inpatient Congestive Heart Failure

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