European Journal of Cardiovascular Medicine

Myocardial infarction (MI), commonly known as a heart attack remains a leading cause of morbidity and mortality worldwide. It is characterized by the irreversible necrosis of heart muscle due to prolonged ischemia, primarily caused by atherosclerotic plaque rupture and subsequent thrombosis in coronary arteries [1]. Despite advances in acute care and secondary prevention strategies, MI patients continue to experience high rates of complications, hospital readmissions, and recurrent cardiovascular events [2]. Effective prevention and management require multidisciplinary approaches, where clinical pharmacists play an increasingly vital role. Clinical pharmacists specialize in optimizing pharmacotherapy, preventing medication-related complications, and providing patient education, thereby improving clinical outcomes. Their interventions include medication reconciliation, monitoring for adverse drug reactions (ADRs), dose adjustments, and ensuring adherence to evidence-based guidelines [3]. This expanded role is particularly crucial in MI management due to the complexity of prescribed therapies, potential drug interactions, and the necessity of long-term adherence to antiplatelet agents, beta-blockers, statins, and other cardiovascular medications [4].

1.2Significance of Clinical Pharmacists in MI Management

Studies have demonstrated that clinical pharmacist-led interventions can significantly reduce medication errors, ADRs, and hospital readmission rates among cardiac patients [5]. Pharmacists’ participation in multidisciplinary teams contributes to personalized treatment plans, timely identification of drug-related problems, and enhanced patient understanding of disease management [6]. Furthermore, pharmacist-led patient counseling on lifestyle modifications, such as smoking cessation, diet, and exercise, supports comprehensive secondary prevention strategies essential for long-term MI recovery [7].

Despite this evidence, the integration of clinical pharmacists in cardiology departments, especially in tertiary care settings, remains inconsistent across healthcare systems [8]. This study seeks to fill this gap by evaluating the direct impact of clinical pharmacists on MI patient care in a tertiary care hospital, thereby providing robust data to support broader clinical pharmacy integration.

1.3 Epidemiology of Myocardial Infarction

Globally, cardiovascular diseases account for approximately 17.9 million deaths annually, with MI constituting a substantial proportion [9]. The burden is higher in low- and middle-income countries, including India, due to risk factors such as hypertension, diabetes, smoking, and sedentary lifestyle [10]. According to recent national surveys, the prevalence of MI has increased steadily over the past decade, highlighting the urgent need for improved preventive and therapeutic interventions.

AIMS AND OBJECTIVES

3.1 Aim of the Study

The primary aim of this study is to evaluate the role and clinical impact of pharmacists in the prevention, management, and post-care optimization of myocardial infarction (MI) in a tertiary care hospital setting.

3.2 Specific Objectives

To achieve the above aim, the study will focus on the following specific objectives:

1. To assess the impact of clinical pharmacists in preventing medication-related complications such as adverse drug reactions (ADRs), drug-drug interactions, and medication errors in MI patients.
2. To evaluate the role of clinical pharmacists in optimizing treatment regimens by ensuring appropriate drug selection, dose adjustments, and adherence to evidence- based guidelines for the pharmacological management of myocardial infarction.
3. Toanalyse the effectiveness of pharmacist-led patient education in improving medication adherence, promoting lifestyle modifications, and enhancing disease awareness during post-myocardial infarction recovery.
4. To determine the influence of clinical pharmacy interventions on clinical outcomes, including reduced hospital readmission rates, prevention of secondary cardiovascular events, and improvement in long-term health status among MI patients.

The study will be conducted at Medicare Hospital and Ajara Hospital, two tertiary care centers equipped with specialized cardiology and pharmacy departments. These hospitals provide advanced cardiac care and clinical pharmacy services integral to myocardial infarction management.

Study Design

This research uses a retrospective and prospective observational cohort study design. The retrospective phase will analyze existing patient records, while the prospective phase involves active monitoring of myocardial infarction (MI) patients to assess clinical pharmacist interventions on drug-related problems (DRPs) and treatment optimization.

Study Period

The study will span six months, from November 2024 to April 2025, allowing comprehensive data collection and follow-up.

Sample Size

The total sample size will be 201 patients diagnosed with myocardial infarction, based on power calculations to detect significant clinical outcomes related to pharmacist interventions.

Study Population and Criteria

Inclusion Criteria

• Patients aged 21 years and above diagnosed with myocardial infarction (MI).
• Both male and female patients.
• Hospitalized patients (inpatients) at Medicare Hospital and Ajara Hospital.
• Patients with documented cardiovascular risk factors such as hypertension, diabetes, and smoking.

Exclusion Criteria

• Patients diagnosed with other heart diseases unrelated to MI.
• Patients with a history of recent major surgery.
• Pregnant women due to different therapeutic protocols.
• Patients with incomplete or missing medical records that could affect data integrity.

Data Collection

Demographic and Clinical Data

Data including age, gender, BMI, comorbid conditions (diabetes, hypertension, dyslipidemia), and MI subtype (STEMI, NSTEMI) will be extracted from medical records. Admission dates, prior cardiovascular history, and baseline lab results will also be collected.

Pharmacological Treatment Data

Information on prescribed medications such as antiplatelets, anticoagulants, beta-blockers, statins, and ACE inhibitors — including dosages and routes of administration — will be reviewed. Medication adjustments and any new additions during hospitalization will be noted.

Identification of Drug-Related Problems (DRPs)

DRPs such as drug interactions, inappropriate doses, adverse drug reactions (ADRs), and therapeutic duplications will be identified through medical and pharmacy records, as well as direct clinical pharmacist evaluations in the prospective phase.

Pharmacist Interventions

Clinical pharmacists will perform medication reviews, provide drug therapy recommendations, counsel patients regarding adherence and lifestyle modifications, and collaborate with healthcare teams to optimize treatment outcomes.

STATISTICAL ANALYSIS: -

For statistical analysis, data were initially entered into a Microsoft Excel spreadsheet and then analyzed using SPSS (version 27.0; SPSS Inc., Chicago, IL, USA) and Graph Pad Prism (version 5). Numerical variables were summarized using means and standard deviations, while Data were entered into Excel and analyzed using SPSS and Graph Pad Prism. Numerical variables were summarized using means and standard deviations, while categorical variables were described with counts and percentages. Two-sample t-tests were used to compare independent groups, while paired t-tests accounted for correlations in paired data. Chi-square tests (including Fisher’s exact test for small sample sizes) were used for categorical data comparisons. P-values ≤ 0.05 were considered statistically significant.

Table 1: Clinical Presentation and Symptom Distribution Among Study Participants (n=201)

Table 2: Comorbidities among Study Participants (n=201)

Table 3: Comorbidity Distribution by Gender (n = 201)

Table 4: Comorbidity Distribution by Age Group (n = 201)

Table5: Utilization of Drug Classes in MI Management

Among the 201 study participants, chest pain was the most common presenting symptom, reported by 161 patients (80%), followed by shortness of breath in 147 patients (73%), radiating chest pain in 91 (45%), and sweating with chest pain in 84 (41%). Generalized weakness (53%), anxiety with palpitations (33%), nausea and vomiting (18%), body or back pain (18%), burning micturition (14%), and pedal edema (2.5%) were also noted. Regarding comorbidities, hypertension was the most prevalent, affecting 122 patients (58%), followed by diabetes mellitus in 56 (27%), past history of PTCA in 14 (6.8%), thyroid disorders in 12 (5.8%), and dyslipidemia in 5 (2.5%). Gender-wise analysis revealed that hypertension and diabetes were slightly more common among males (61.5% and 25.6%) compared to females (59.5% and 31.0%), whereas thyroid disorders were more prevalent in females (7.1% vs. 5.1%). Age-based distribution showed that hypertension and diabetes increased markedly after 40 years, with the highest prevalence in the 41–60 and 61–80 age groups. Notably, comorbidities such as thyroid disorders and diabetes were also observed in the elderly (>80 years). In terms of pharmacological management, all patients received antiplatelets/anticoagulants and statins. Beta-blockers and nitrates were prescribed to 62% of patients, while ACE inhibitors/ARBs and calcium channel blockers were used less frequently (4% and 6%, respectively). Diuretics were prescribed in 13% of cases.

In the present study, chest pain was the predominant presenting symptom among patients with myocardial infarction (MI), reported in 80% of cases, followed by shortness of breath (73%) and radiating chest pain (45%). These findings are consistent with the observations of Kumar et al., who reported chest pain in 82% and dyspnea in 70% of their cohort of 250 acute coronary syndrome (ACS) patients [11]. Sweating associated with chest pain (41%) and generalized weakness (53%) were also frequently encountered in our study, in line with the results of Gupta et al., who documented autonomic symptoms such as sweating and weakness in 47% of MI cases [12]. Less common presentations, including nausea and vomiting (18%), body or back pain (18%), and burning micturition (14%), highlight the atypical symptom spectrum of ACS, particularly in elderly patients and females, as previously emphasized by Canto et al. [13].

With respect to comorbidities, hypertension (58%) and diabetes mellitus (27%) were the leading risk factors in our study population. This observation correlates with the INTERHEART study, which demonstrated that hypertension and diabetes remain the most significant modifiable contributors to MI globally [14]. The prevalence of hypertension in our study was slightly higher than that reported by Prabhakaran et al. (52%) in Indian ACS patients [15], while diabetes prevalence (27%) closely mirrors that of Mohan et al. (29%) in South Indian populations [16]. Thyroid disorders were noted in 5.8% of patients, more frequently among females, which concurs with the findings of Singh et al., who highlighted a higher predisposition of thyroid dysfunction in female cardiac patients [17].

Age-wise analysis in our study revealed an increasing prevalence of hypertension and diabetes with advancing age, particularly between 41–60 years and 61–80 years. Similar age trends were documented by Karthikeyan et al., who reported that cardiovascular risk factors cluster markedly after the fourth decade of life in Indian cohorts [18]. Importantly, even in the elderly (>80 years), comorbidities such as diabetes and thyroid disorders were documented, suggesting the cumulative burden of metabolic dysfunction in late life, corroborated by Yusuf et al. [19].Regarding pharmacological management, nearly all patients received antiplatelets/anticoagulants and statins, reflecting adherence to international guideline-based therapy [20]. Beta-blockers and nitrates were used in 62% of patients, while ACE inhibitors/ARBs and calcium channel blockers were prescribed less frequently, a pattern similar to that reported by Joseph et al., where beta-blockers were administered in 60% and ACE inhibitors in 8% of ACS patients [5]. The relatively lower use of ACE inhibitors/ARBs (4%) and CCBs (6%) in our study could be attributed to patient comorbidities, hemodynamic status, and treating physician preference.Overall, the findings from our study not only reaffirm the classical risk profile and clinical presentation of MI but also highlight regional variations in comorbidities and pharmacological management, underscoring the need for context-specific strategies in optimizing care.

In this study of 201 patients with myocardial infarction, chest pain emerged as the most common presenting symptom, followed by dyspnea and radiating chest pain, highlighting the classical clinical profile of MI in a tertiary care setting. A significant proportion of patients also experienced generalized weakness, autonomic symptoms, and atypical manifestations, underlining the need for heightened clinical suspicion, especially in elderly and female patients. Hypertension and diabetes mellitus were identified as the predominant comorbidities, with their prevalence rising markedly after the age of 40 years. Thyroid disorders, though less frequent, were observed predominantly in females, while dyslipidemia remained comparatively rare in this cohort. Pharmacological management reflected adherence to guideline-directed therapy, with universal use of antiplatelets/anticoagulants and statins, and the majority receiving beta-blockers and nitrates, though the use of ACE inhibitors/ARBs and calcium channel blockers was limited.Overall, the findings underscore the importance of early recognition of both typical and atypical presentations of MI, as well as the strong association with comorbid conditions such as hypertension and diabetes. The study also highlights the rational application of pharmacological strategies in secondary prevention. Strengthening risk factor modification, ensuring strict adherence to evidence-based drug regimens, and tailoring therapy to patient comorbidities remain crucial in improving clinical outcomes and reducing the burden of recurrent cardiovascular events.

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