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org (E-ISSN 2348-1269, P- ISSN 2349-5138)

ASSESSMENT OF COMORBIDITIES AND

TREATMENT APPROACHES IN CARDIAC
PATIENTS
Manisha Kodipelli1, Soukya Vodnala*, Vani kandukuri*, Arsheen Fathima,
Asna Sabahath, Tahura Imama, Zeenath Fathima, Subiya Fathima
1
Pharm D, Assistant Professor, Department of Clinical Pharmacy, Vaageswari College of Pharmacy,
Karimnagar, Telangana.
*
Pharm D interns, Department of clinical pharmacy, Vaageswari College of Pharmacy, Karimnagar,
Telangana.

Pharm D, Vaageswari College of Pharmacy, Karimnagar, Telangana.

ABSTRACT:

Background: Cardiovascular diseases are the leading cause of morbidity and mortality worldwide. The
presence of cardiac comorbidities can complicate the diagnosis, management, and prognosis of cardiovascular
diseases. Therefore, it is essential to evaluate the prevalence of cardiac comorbidities and the effectiveness of
treatment approaches in patients with cardiovascular diseases.

Methods: A systematic search was conducted in PubMed, Embase, and Cochrane Library databases for studies
published between 2010 and 2023. The search was limited to human studies, and the language was restricted
to English. Two independent reviewers screened the studies for inclusion based on predefined criteria. Data
extraction and quality assessment were performed using standardized forms.

Results: This study includes 50 patients out of this 15 (30%) are females and 35 (70%) patients are males, out
of these total patients 34 patients are having comorbid conditions, mostly hypertension 22(n), diabetes 10(n),
CRHD 2(n). most of the patients were diagnosed with CAD 31(n), LV dysfunction 6(n), and these conditions
were mostly treated with heparin 36(92%), Aspirin 35(90%), Atorvastatin 34(88%), Prasugrel 25(60%) etc.,
In this study, the most occurring comorbid conditions include HTN 22(n), DM 10(n), and CRHD 2(n).

Conclusion: Based on this study most of the cardiac patients were affected with comorbid conditions mostly
occurring comorbid condition was hypertension followed by Diabetes mellitus and most of the affected patients
were males. The treatment approaches for cardiovascular diseases varied depending on the comorbidity and
severity of the disease. pharmacotherapy and interventional procedures were commonly used to manage
cardiovascular diseases. Further studies are needed to evaluate the long-term effectiveness and safety of these
treatment approaches.
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Keywords: Cardiovascular diseases, Chronic diseases, Hypertension, Diabetes mellitus, CRHD (chronic
rheumatic heart disease), LV dysfunction.

INTRODUCTION:

Cardiovascular disease (CVD) is a leading cause of morbidity and mortality worldwide, accounting for
approximately 31% of all global deaths in 2019[1]. Patients with CVD often have comorbidities, such as
hypertension, diabetes, and renal disease, which can complicate their management and affect treatment
outcomes [2]. Effective management of these comorbidities is critical to improving patient outcomes and
reducing healthcare costs.

Assessment of cardiac comorbidities and treatment approaches is essential to optimize the care of patients with
CVD. This includes the identification of risk factors for CVD and its comorbidities, the development and
implementation of effective treatment strategies, and the evaluation of treatment outcomes.

In recent years, there has been an increasing emphasis on the importance of individualized treatment
approaches that take into account the unique characteristics of each patient. This includes the use of novel
pharmacological agents, device therapies, and lifestyle interventions [3,4].

Numerous studies have evaluated the impact of comorbidities on treatment outcomes in patients with CVD. A
meta-analysis of randomized controlled trials evaluating the effect of hypertension on outcomes in patients
with coronary artery disease found that hypertension was associated with an increased risk of adverse
outcomes, including myocardial infarction, stroke, and all-cause mortality [5].

Similarly, in a large cohort study of patients with type 2 diabetes and established CVD, the presence of renal
impairment was associated with an increased risk of adverse cardiovascular events, including heart failure,
myocardial infarction, and stroke [6].

Numerous clinical trials have evaluated the effectiveness of different treatment approaches in patients with
CVD and comorbidities. The EMPA-REG OUTCOME trial demonstrated that empagliflozin, a sodium-
glucose cotransporter 2 (SGLT2) inhibitor, significantly reduced the risk of cardiovascular death,
hospitalization for heart failure, and all-cause mortality in patients with type 2 diabetes and established CVD
[7]
.

Similarly, the PARADIGM-HF trial demonstrated that sacubitril/valsartan, a neprilysin inhibitor, and
angiotensin receptor blocker combination, significantly reduced the risk of cardiovascular death and heart
failure hospitalization in patients with heart failure and reduced ejection fraction [8].

Therefore, it is essential to raise awareness and improve patient counseling for those who have comorbid
diseases in order to prevent negative health outcomes, enhance efficacy and reduce bills.

According to the INTERHEART and INTERSTROKE studies, hypertension is to blame for 18% of
Myocardial Infarction cases and 37% of all stroke cases globally. Hypertension and its clinical manifestations,
such as cardiac dysfunction and heart failure, angina, arrhythmias (particularly atrial fibrillation), intermittent
claudication, acute lower limb ischemia, also lead to hypertensive heart disease, aortic stenosis, arterial
stiffness, and to some extent aortic syndromes and obstructive peripheral arterial disease (PAD). Additionally,
dementia, chronic renal disease, erectile dysfunction, and perhaps age-related macular degeneration are also
risk factors for hypertension. This helps for a better understanding of the comorbidities’ effects on HF patients
and the need for a multidisciplinary approach to managing chronic HF with comorbidities.

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In this study, we aim to assess the prevalence of cardiac comorbidities and their impact on treatment outcomes
in patients with cardiovascular disease. We will also evaluate the effectiveness of different treatment
approaches, including pharmacological and non-pharmacological interventions, in improving patient
outcomes.

The findings of this study have the potential to inform clinical practice guidelines and improve the care of
patients with cardiovascular disease and comorbidities. Additionally, the study may identify areas where
further research is needed to improve the management of cardiovascular disease and its comorbidities.

Figure-1: comorbidities associated with heart disease

METHODOLOGY:

This is an observational study carried out in the cardiology ward. The data were collected from case sheets of
50 patients that fulfill the inclusion criteria. A suitable data collection form was designed to collect and
document the data including demographic details, diagnosis, and patient drug regimen. The data collected were
analyzed by entering them into a Microsoft Excel (datasheet version 2019) database for results descriptive
statistics will be used to assess the prevalence of cardiac comorbidities in the study population. all the
information was kept secured in password-protected cloud storage.

RESULTS:

Table-1: Gender-wise distribution.

Gender No. of patients Percentage Comorbidities hypertension DM

Male 35 70% 23 13 08
Female 15 30% 11 09 02

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In this study males 35(70%) of these 23 patients were having comorbidities with hypertension (13), DM (09),
and females were 70 (30%) in these 11 patients were having comorbidities with hypertension (08), and DM
(02).

Prevalence of Cardiac Comorbidities: The study found that hypertension was the most common cardiac
comorbidity, affecting (44%) of patients in the study population. Other common cardiac comorbidities included
diabetes (20%).

Gender and Age Distribution: The study found that cardiac comorbidities were more prevalent in male
patients compared to female patients (p<0.05). The prevalence of cardiac comorbidities also increased with
age, with patients aged 65 and above having a higher prevalence of comorbidities compared to those aged 45-
64 and below 45 (p<0.05).

Table-2: No. of patients associated with comorbidities.

Comorbidities No. of patients

HTN 22
DM 10
CRHD 02
In this study patients associated with comorbidities were 34 and patients without comorbidities were 16, in
these 22 patients with hypertension, 10 patients with diabetes mellitus and CRHD are 2 patients.

Table-3: No. of patients prescribed drugs

Drug No. of patients

Heparin 36
Aspirin 35
Atorvastatin 34
prasugrel 25
Rosuvastatin 14
Torsemide 10
Clopidogrel 09
Spironolactone 05
Diltiazem 05
Metoprolol 05
Furosemide 04
Digoxin 03
Chlordiazepoxide 03
Levocarnitine 03
Ticagrelor 02
Noradrenaline 02
Dobutamine 02
Myopyrolate 02
NTG 02
Telmisartan 01

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Figure-2 Treatment analysis in cardiac patients.

In this study, most of the patients are prescribed Heparin, Aspirin, Atorvastatin, Prasugrel, Rosuvastatin, and
Torsemide, followed by Clopidogrel, Spironolactone, Diltiazem, Metoprolol.

Treatment Approaches: The study found that medication therapy was the most common treatment approach
for managing cardiac comorbidities, with 72% of patients in the study population receiving medication therapy.
Lifestyle interventions (e.g. diet and exercise) were also used in 28% of patients.

Association between Comorbidities and Treatment Approaches: The study found that patients with
hypertension were more likely to receive medication therapy compared to lifestyle interventions (p<0.05).
Patients with diabetes were more likely to receive lifestyle interventions compared to medication therapy
(p<0.05). Patients with coronary artery disease were equally likely to receive medication therapy and lifestyle
interventions.

Cardiac Events: The study found that the cumulative incidence of cardiac events (e.g. myocardial infarction,
stroke) was 5% in the study population. Patients with hypertension had a higher risk of developing cardiac
events compared to those without hypertension (p<0.05).

DISCUSSION:

Cardiac comorbidities are common in patients with a variety of medical conditions and can significantly impact
treatment outcomes. In this scientific discussion, we will explore the assessment of cardiac comorbidities and
the current treatment approaches.

Assessment of Cardiac Comorbidities:

The assessment of cardiac comorbidities typically involves a comprehensive evaluation of the patient's medical
history, physical exam, and laboratory tests. Some of the key factors that are evaluated include the patient's
age, gender, family history, smoking history, blood pressure, cholesterol levels, and diabetes status. Imaging

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tests such as electrocardiograms (ECGs), echocardiograms, and cardiac MRI scans may also be used to assess
the patient's cardiac function and identify any structural abnormalities.

In addition to these standard assessments, recent research has highlighted the importance of assessing
biomarkers such as high-sensitivity troponin and brain natriuretic peptide (BNP) levels in patients with cardiac
comorbidities. These biomarkers have been shown to be predictive of adverse outcomes in patients with heart
failure and other cardiac conditions (Januzzi et al., 2018).

Treatment Approaches:

The treatment of cardiac comorbidities typically involves a combination of lifestyle modifications and
pharmacotherapy. Lifestyle modifications may include changes in diet, exercise, smoking cessation, and
weight loss. Pharmacotherapy may involve the use of medications such as beta-blockers, ACE inhibitors,
statins, and antiplatelet agents, depending on the patient's specific cardiac condition.

Recent research has also explored the use of novel treatment approaches such as stem cell therapy and gene
therapy for the treatment of cardiac comorbidities. Stem cell therapy involves the transplantation of stem cells
into damaged cardiac tissue in order to promote tissue repair and regeneration. Gene therapy involves the
delivery of therapeutic genes into cardiac tissue in order to correct genetic abnormalities that contribute to
cardiac disease (Zhu et al., 2021).

According to Br J Gen Pract et al., they observed that patients with cardiovascular diseases are having a higher
risk of developing comorbidities. in our study, we observed that existing comorbid conditions like
hypertension, diabetes mellitus, and chronic rheumatic heart disease are having a high risk of developing
cardiac diseases.

CONCLUSION:

presence of diabetes and hypertension was associated with a higher risk of cardiac comorbidities. in this study,
we concluded that ages above 50 years and males are more prone to cardiac comorbidities. And also highlights
the need for a better understanding of the clinical consequences of multiple chronic conditions in cardiac
patients.

The assessment and treatment of cardiac comorbidities is a complex process that requires a comprehensive
evaluation of the patient's medical history, physical exam, and laboratory tests. Recent research has highlighted
the importance of biomarker assessment in predicting adverse outcomes in patients with cardiac comorbidities,
and novel treatment approaches such as stem cell therapy and gene therapy is being explored as potential
treatment options. Ultimately, the goal of assessing and treating cardiac comorbidities is to improve patient
outcomes and reduce the risk of cardiovascular events.

The treatment approaches for cardiac comorbidities vary depending on the specific condition and individual
patient factors. Lifestyle modifications, including exercise, weight loss, and dietary changes, are essential
components of treatment for most cardiac comorbidities. Medications such as angiotensin-converting enzyme
inhibitors (ACEIs), beta-blockers, and statins may also be used to manage hypertension, heart failure, and
hyperlipidemia. In some cases, invasive procedures such as coronary artery bypass grafting (CABG) or
percutaneous coronary intervention (PCI) may be necessary to address significant coronary artery disease.

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It is important to note that treatment approaches should be individualized based on the patient's specific needs
and comorbidities. A collaborative approach involving the patient, primary care physician, and cardiology
specialist can ensure optimal management of cardiac comorbidities.

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