Are patients suffering from stable angina receiving optimal medical treatment?
There is good evidence for the use of antiplatelet, beta-blocker and lipid-lowering drugs in the treatment of ischaemic heart disease, but few data on how these medications are used in treating stable angina pectoris. We examined prescription profiles for a sample of patients aged > or =65 years with stable angina, to compare the profiles to local guidelines and to explore the determinants of these profiles, in a cross-sectional study. We identified 11 141 individuals from the Quebec provincial out-patient pharmaceutical database for the period 1 June 1996 to 31 May 1997, and examined the percentage of these patients with and without associated co-morbidities receiving antiplatelet, beta-blocker and lipid-lowering medications. We used hierarchical modelling to examine the role of patient and physician characteristics in explaining the variation in the use of these medications. Calcium-channel blockers were the class of anti-ischaemic drugs most prescribed (63%). Beta-blockers were prescribed in 52.1% of patients. Antiplatelet and lipid-lowering drugs were prescribed to 56.8% and 32.6%, respectively. Increasing age and female gender made patients less likely to be prescribed these treatments. General practitioners were less likely than cardiologists to prescribe beta-blockers and lipid-lowering drugs (OR 0.79, CI 95% 0.68-0.91 and OR 0.77, CI 95% 0.66-0.91, respectively). There is a general under-use of antiplatelet, beta-blocker and lipid-lowering medications in the treatment of stable angina pectoris patients, possibly leading to adverse patient outcomes.
Beaulieu
M D
MD
Groupe Interdisciplinaire de Recherche en Santé (GRIS), Hospitalier de l'Université de Montréal, Pavillon Louis-Charles Simard, Pavillon Notre-Dame, 1560 Sherbrooke Est, Montréal (Quebec) H2L 4M1, Canada. maried.beaulieu@sympatico.ca
Blais
R
R
Jacques
A
A
Battista
R N
RN
Lebeau
R
R
Brophy
J
J
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000367:Age Factors; D000368:Aged; D000787:Angina Pectoris / Q000188:drug therapy*; D003430:Cross-Sectional Studies; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D000960:Hypolipidemic Agents / Q000627:therapeutic use*; D016015:Logistic Models; D008297:Male; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D012737:Sex Factors
D000319:Adrenergic beta-Antagonists; D000960:Hypolipidemic Agents; D010975:Platelet Aggregation Inhibitors