Suboptimal pharmacotherapeutic management of chronic stable angina in the primary care setting.
OBJECTIVE
To assess the adequacy of symptomatic treatment for chronic stable angina among primary care patients who receive care from the Department of Veterans Affairs (VA).


METHODS
We conducted a cross-sectional analysis involving 7038 veterans with self-reported coronary heart disease who completed the Seattle Angina Questionnaire and who had made a primary care visit to one of seven VA general internal medicine clinics between May 1997 and January 2000. The main outcome measures included the anginal frequency scale of the questionnaire and receipt of prescriptions for antianginal medication in three classes (beta-blockers, calcium antagonists, and long-acting nitrates).


RESULTS
Seventy percent of the patients experienced angina or took sublingual nitroglycerin preparations two or fewer times per week. Of the 30% of patients with more frequent symptoms, 22% were receiving no antianginal medications and 33% were receiving only one class of antianginal medication. Of the patients with frequent angina who were prescribed medications, 18% were taking no medications at the recommended therapeutic dose and 50% were receiving only one class of antianginal medication at the recommended therapeutic dose.


CONCLUSIONS
A substantial proportion of patients with frequent episodes of chronic stable angina appeared to be receiving an inadequate antianginal regimen in terms of number of agents and dosages. While numerous studies have described inadequate treatment of asymptomatic conditions and risk factors, our results suggest similar deficiencies in addressing a serious and eminently treatable symptomatic problem.
Health Services Research and Development Center of Excellence, Veterans Affairs Puget Sound Health Care System, Seattle, WA 98108, USA.
Francine C
FC
Wiest
Chris L
CL
Bryson
Marcia
M
Burman
Mary B
MB
McDonell
Jorja G
JG
Henikoff
Stephan D
SD
Fihn
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000368:Aged; D000787:Angina Pectoris / Q000188:drug therapy* / Q000453:epidemiology; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D002908:Chronic Disease; D003327:Coronary Disease / Q000188:drug therapy / Q000453:epidemiology; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017060:Patient Satisfaction; D011320:Primary Health Care; D012307:Risk Factors; D013223:Statistics as Topic; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
D000319:Adrenergic beta-Antagonists; D002121:Calcium Channel Blockers