Appropriateness of Sildenafil Prescribing in Pulmonary Hypertension with Valvular Heart Disease: A Single Centre Study

Oral sildenafil has proven efficacy in pulmonary hypertension in current clinical practice. However, there is a research gap in sildenafil prescribing among patients with valvular heart disease (VHD) and pulmonary hypertension (PH) in Malaysia. This study aimed to determine the appropriateness of sildenafil prescribing and rehospitalization rate in patients with corrected VHD and PH. This is a retrospective descriptive study using universal sampling with a calculated sampling size of 123. Patients who were diagnosed with VHD and PH in Hospital Serdang were recruited from 2014 - 2018. Patients' demographic and clinical characteristics were retrieved from Electronic Hospital Information System (eHIS) and recorded using a pre-designed data collection form. Appropriateness prescribing of sildenafil included appropriate dose(20mg to 80mg three times daily) and duration(total of eight weeks of sildenafil treatment that started before and continued after surgery). Rehospitalization is defined as any hospitalization within six months after surgery. Data were analyzed using descriptive and inferential statistics. From 123 patients (44.7% male, 55.3% female), 41% (n=51) and 61.8%(n=76) received appropriate dose and duration of Sildenafil respectively. Rehospitalization rate within six months after valve surgery was 55.3%(n=68). Univariate analysis showed that patients more than 65 years old (p=0.039), atrial fibrillation (AF) (p=0.04) and female (p=0.002) received appropriate prescribing of sildenafil. Only female patients and patients with AF were the predictors of appropriate prescribing of sildenafil. The role of sildenafil in VHD and PH remains unclear and needs further research in different perspectives such as short term and long-term duration with different doses.