PURPOSE: 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. CONCLUSION: 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.
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PURPOSE: 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. CONCLUSION: 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.
Authors: Faraz Kureshi; Ali Shafiq; Suzanne V Arnold; Kensey Gosch; Tracie Breeding; Ashwath S Kumar; Philip G Jones; John A Spertus Journal: Clin Cardiol Date: 2016-11-07 Impact factor: 2.882
Authors: Mary E Plomondon; David J Magid; Frederick A Masoudi; Philip G Jones; Lisa C Barry; Edward Havranek; Eric D Peterson; Harlan M Krumholz; John A Spertus; John S Rumsfeld Journal: J Gen Intern Med Date: 2007-10-23 Impact factor: 5.128
Authors: Pamela N Peterson; John A Spertus; David J Magid; Fredrick A Masoudi; Kimberly Reid; Richard F Hamman; John S Rumsfeld Journal: BMC Cardiovasc Disord Date: 2006-10-24 Impact factor: 2.298
Authors: Daniel M Blumenthal; Sidney E Howard; Jennifer Searl Como; Sandra M O'Keefe; Steven J Atlas; Daniel M Horn; Neil W Wagle; Jason H Wasfy; Robert W Yeh; Joshua P Metlay Journal: JAMA Netw Open Date: 2021-06-01