Are patients suffering from stable angina receiving optimal medical treatment?

• Published in: QJM : An International Journal of Medicine 2001-06, Vol.94 (6), p.301-308
• Main Authors: Beaulieu, M.‐D., Blais, R., Jacques, A., Battista, R.N., Lebeau, R., Brophy, J.
• Format: Article
• Language: English
• Subjects: Adrenergic beta-Antagonists - therapeutic use; Age Factors; Aged; Angina Pectoris - drug therapy; Cross-Sectional Studies; Female; Guideline Adherence; Humans; Hypolipidemic Agents - therapeutic use; Logistic Models; Male; Platelet Aggregation Inhibitors - therapeutic use; Practice Guidelines as Topic; Practice Patterns, Physicians; Sex Factors
• ISSN: 1460-2725; 1460-2393; 1460-2393
• DOI: 10.1093/qjmed/94.6.301

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 ≥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.