Knowledge, Attitude and Practice of Ischemic Heart Disease Patients towards Their Medication

Objective: Ischemic heart disease is mostly seen among all Cardiovascular diseases and is responsible for more than 80% of cardiovascular disease deaths. This study has been developed to design and to validate a Knowledge, attitude and practice (KAP) Questionnaire in order to assess the knowledge, attitude and practice of ischemic heart disease patients towards their medications. Study Design: Prospective observational study Methods: The study was conducted for duration of six months among 336 patients. The study subjects taken were above 18 years of age, who was diagnosed with Coronary Artery Disease by a Consultant Cardiologist in Cardiology Department. Practice questionnaires and all the details were explained by the investigator before filling the KAP forms. The data was tabulated and statistically analysed by SPSS software. Original Research Article Akshay et al.; JPRI, 33(58A): 256-262, 2021; Article no.JPRI.78977 257 Results: 336 patients including both males and females were enrolled in the study. Majority of the patient were having good knowledge about the disease conditions that is 50% of the patients were aware about the ischemic heart disease. 326 (97%) of the 336 research participants were aware of the signs and symptoms of ischemic heart disease. Majority of the patient have an attitude towards the adverse conditions related to the disease i.e. 91.4% were aware of consulting a physician when they came across a side effect. 85.45% of the study subjects think that non-compliance to medication can lead to worsening of their condition. 98.2% of the study subjects are willing to take the treatment recommended by their doctor. Considering the practice, 81.5% the study subjects were ready to follow all the instructions given by the doctor. Conclusion: Findings from this study provide a better understanding of “knowledge, attitude and practice” in Ischemic heart disease patients towards their medications. Estimating the knowledge, attitude and practices of the community has sufficiently provided crucial baseline information for the implementation of primary and secondary preventive programs.


INTRODUCTION
One of the most common cause for the mortality in India was found to be Cardiovascular diseases (CVDs). Stroke and Ischemic heart disease are most seen among all CVDs and are responsible for >80% of CVD deaths [1].
Coronary artery disease (CAD), also named as "coronary heart disease (CHD)" or "ischemic heart disease (IHD)", defined as reduced flow of blood to the heart muscle (myocardium) due to build-up of a thick block known as plaque in coronary arteries. Atherosclerosis of epicardial coronary arteries is the main etiology of IHD. As a result of atherosclerosis in coronary arteries leads to increase of myocardial oxygen demand and decreased supply of myocardial oxygen [2]. Coronary artery disease typically causes shortness of breath, angina pectoris, myocardial infarction, or heart attack [3]. Common symptoms of IHD is Pain in shoulder, arm, back, neck or jaw, which may be radiated from chest pain, even if patients have same type of coronary heart disease, symptoms may vary from person to person. [4]. Coronary artery disease is associated with number of risk factors. Out of which few are controllable and few are not controllable. Controllable risk factors are high blood cholesterol levels, high BP, smoking, diabetes, overweight or obesity, stress, unhealthy diet and lack of physical activity. Uncontrollable risk factors are family history, race, Distribution of patients according to their diagnostic tests, and age (Advanced age increases risk) [5]. If risk factors are in control, 90% of cardiovascular diseases maybe preventable but it does not completely cure [6]. Treatment for coronary artery disease typically  includes modifications to lifestyles and, if  necessary,  drugs  and  certain  medical procedures. For the treatment of coronary artery disease, different medications can be used, including, cholesterol lowering drugs, antiplatelet drugs, anticoagulant drugs, anti-anginal drugs, beta blockers, angiotensin converting enzyme (ACE) inhibitors, angiotensin II receptor blockers. Medical procedures include angioplasty and stent placement, coronary artery bypass surgery [7]. This study adequately provides key baseline information to design future preventive educational interventions.

MATERIALS AND METHODS
A prospective observational hospital-based study was performed at a teaching hospital in the Department of Cardiology for the duration of six months. The Institutional Ethics Committee approval was obtained before initiating the study. The sample size was calculated to be 336 by considering the availability of patients during the study period. Eligibility criteria include all patients above 18 years of age who were diagnosed with ischemic heart disease by a consultant cardiologist in cardiology department and in medication for 3 months. For this analysis, the exclusion criteria were critically ill patients, patients who were diagnosed with other cardiac disease, patients who were not willing to participate and pregnant women.
A self-administered questionnaire that consisted of 14 questions which were divided into 3 categories mainly Knowledge, attitude and practice was developed to conduct the research. The Knowledge category consisted of 4 questions whereas attitude and practice category consisted of 5 questions each. Two or three options were given for each question. Developed questionnaire were validated by physicians (n=3) and academic pharmacists (n=2). Spelling and logical errors in the questionnaire were corrected by obtaining the feedback after the validation process. The finalized questionnaire was translated into local languages for the easy understanding of study subjects. After the translation process, the back translation of the questionnaire was carried out for confirming the appropriateness of the questionnaire. Participants were enrolled and interviewed by using KAP questionnaire and the scores were documented.

Knowledge Assessment of Study Population
As per the first criteria of the knowledge questionnaire, 50% of the patients knows what Ischemic heart disease is. 326 study subjects (97%) among 336 were aware of the signs and symptoms of ischemic heart disease. In the study sample, 66.1% have knowledge about the diet plan, which should be followed during the disease condition. The detailed knowledge assessments are given in Table 1.

Attitude Assessment of Study Population
While assessing the attitude of study subjects, 91.4% are aware of consulting a physician when they come across a side effect. Only 8.6% are disagreeing the fact. 85.45% of the study subjects think that non-compliance to medication can lead to worsening of their condition. 98.2% of the study subjects are willing to take the treatment recommended by their doctor only 1.8% of the study subjects are disagreeing the fact. Attitude assessment of study population was discussed in detail in Table 2.

Practice Assessment of Study Population
While considering the practice of study subjects conducted during the study, 81.5% are following the instructions regarding the intake of medication given by their doctor. 90.8% of the study subjects are aware that they are supposed to consult their physician when their medication gets over according to the prescription. 77.4% of the study subjects are aware that they have to attend the check up regularly as directed by their physician. Practice assessment of study population was discussed in detail in Table 3.

Discussion
In the present study, 69.3% of males and 30.7% of females participated. Among which majority of sample populations were male and majority of participants fall under the age group between 60-70years (36.3%) followed by age group 50-60 (25.9%). In the study conducted by Mirza et al., shows a similar result in which majority of sample populations were male, and more than half of the population of the sample (55%) was 41-70 years of age.
In the present study, 97% of the patients were aware of the signs and symptoms of ischemic heart disease. In the study conducted by Mirza et al., shows an inconsistent result in which 71% of the patients were not adequately to establish an appropriate signs and symptoms of ischemic heart disease [8].
In the present study, 50% of the patients know what Ischemic heart disease is. 97% of the patients were aware of the various symptoms and signs of ischemic heart disease and 66.1% have knowledge about the diet plan, which should be followed during the disease condition. Similar findings were obtained from a study conducted by Muhammed et al., in which half of the subjects were able to correctly answer general CVD questions [9].
In the present study, more than half of ischemic patients were found to be smokers. Study concluded that tobacco use is one of the major risk factor in CVDs. Similar result was found from the study conducted by Yahya et al., in where 56.8% were found to be using tobacco products and 41.3% noted as having CVD related medical conditions [10].
In the present study, there is significant (p=0.04) association between Knowledge regarding IHD in the age group and educational qualification. Respondents with age group of 30 -50 and graduates were correctly identified what is IHD. In the study conducted by Hertz et al., shows a similar result in which higher IHD knowledge was found to be connected with younger age (P = 0.045) and higher education (P < 0.001) but not higher risk of cardiovascular disease (P = 0.123) [11].
In the present study, there is significant (p=0.04) association found regarding IHD dietary plan and educational qualification.
The graduate respondents were about the dietary plan of IHD. This result was consistent with the study conducted by Perera et al., that education status had a significant relationship with knowledge and attitude about dietary management (knowledger = 0.48, p < 0.001, Attituder = 0.44, p < 0.001) [12].
In the present study, majority of participants fall under the age group between 60-70years (36.3%) followed by age group 50-60 (25.9%). This outcome contradicted the outcome of the study conducted by Nadeem et al., which included 109 patients with a mean age of 41 years [13].

CONCLUSION
The study developed a structured knowledge attitude and practice questionnaire for assessing knowledge attitude and practice of ischemic heart disease patients towards their medication. In present study a total number of 336 patients were included out of which 233 are male and 103 are female. As per Kap questionnaire 50% of the patients had sufficient knowledge about ischemic heart disease and their signs and symptoms. While assessing the attitude of the study subjects majority of the patients were aware about the adverse conditions related to the disease. Considering the practice, 81.5% the study subjects were ready to follow all the instructions given by the doctor. It was found that respondents who were graduates had more knowledge regarding the dietary plan and the disease conditions. Respondents who were HS and HSS qualified had followed all the instructions given by the doctor.
This study concluded that estimation of a population's knowledge, attitude and practices has been adequately providing key baseline information to design primary and secondary prevention programmes.

CONSENT
As per international standard or university standard, patients' written consent has been collected and preserved by the author(s).

ETHICAL APPROVAL
The Institutional Ethics Committee approval was obtained before initiating the study.