Coronary Artery Disease (CAD), is the predominant cardiovascular disease with a substantial contribution towards cardiovascular morbidity, mortality includes cardiomyopathies, Acute Myocardial Infarction (AMI), angina pectoris, Congestive Heart Failure (CHF), and myocarditis.1 Myocardial Infarction (MI), the most frequent type of CAD, develops when a coronary artery is completely blocked or almost blocked, leading to a substantial reduction in blood flow and the infarction of a portion of the heart muscle that is carried by that artery.2 Acute myocardial infarctions come in two different forms: ST-segment Elevation Myocardial Infarction (STEMI) and Non-ST-segment Elevation Myocardial Infarction (NSTEMI). Unstable angina is comparable to NSTEMI.3

Around 17.5 million people die from these cardiovascular illnesses each year, making them the largest cause of morbidity and mortality in the world. More than 75% of these deaths take place in Low-and Middle-Income Countries (LMIC). Although the death rate due to cardiovascular complications are dropped in several high-income nations, the trend in LMIC has not been the same.1,4–6 Coronary artery disease is the main cause of mortality worldwide, with rates found in LMIC significantly driving this upward trend from 6.1 million deaths in 1990 to 9.5 million in 2016.7 Between 1990 and 2010, the number of healthy life years-lost due to ischemic heart disease increased by 73% in South Asia, one of the world’s most densely populated regions, compared to the global growth of 30%. South Asia also bears the heaviest burden of cardiovascular illnesses internationally.1–11

Furthermore, compared to those from other countries, South Asians have been observed to have their first MI almost ten years earlier.1,13 And today, four out of every five deaths from ischemic heart disease take place in LMIC, primarily impacting working-age people leads to greater financial challenges for the country.14 By 2025, the World Health Organization (WHO) aims to achieve a 25% relative decrease in non-communicable disease related premature mortality among CVD patients between the ages of 50 and 70. As a result, efforts must be focused on lowering the incidence of CVD in LMIC through two main strategies i.e., first, increasing prevention by addressing risk factors and lowering the case fatality rate for the two main causes of death, MI and stroke, and second, enhancing access to treatment that is based on the best available scientific evidence.15

MI has been the most common cardiovascular emergency seen in the emergency department, becoming the leading cause of death due to CVD in India. Although improvements in healthcare systems and the execution of efficient public health policies have reduced the prevalence of MI in industrialized countries, rates are rising in emerging nations like India. Evidence-based clinical practice guidelines provide guidance on effective and timely management of CAD, utilization of which is not consistent particularly in developing countries.16 Therefore, management of MI should be based on evidence derived from the regional clinical trials data or expert opinion and conclusions drawn based on available evidence. Among the available medications, a few are used to terminate the attack of MI (used as and when required bases) while a few are indicated for long-term management to prevent the frequency of the attack and halt the progression of the disease. The various category of drugs includes Angiotensin-Converting Enzyme inhibitors (ACEi)/ Angiotensin-II Receptor Blockers (ARBs), statins, antianginal agents, anticoagulants, antiplatelet medications, adrenergic P-blockers, calcium channel blockers, diuretics, etc. are listed.

Various guidelines are proposed by various agencies across the globe for the effective management of CVD including The American College of Cardiology (ACC), American Heart Association (AHA), European Society of Cardiology (ESC), Society for Cardiovascular Angiography and Interventions (SCAI) while In India, guidelines are set by Association of Physicians of India (API) and Cardiology Society of India (CSI).17

High-income nations have well-established screening, evaluation, and management procedures for CAD, but India has not fully adopted these strategies.18 Research from all across the world shows that statins, antiplatelet medications, ACEi, and P-blockers are still prescribed insufficiently, and reperfusion treatment for acute MI is still remarkably underutilized.1,20 In the current study, we examined trends in the prescription patterns of medications used in MI patients conducted at A Tertiary Care Hospital in the Rayalaseema Region of Andhra Pradesh, India.