Angina patients often under-medicated

A large Veteran's Administration study has shown that "a substantial proportion" of people with chronic stable angina do not receive optimal drug therapy.

At seven VA hospitals across the country, researchers analyzed questionnaires completed by 7038 active patients at the hospitals' clinics who reported having heart-related chest pain.

According to a report in the American Journal of Medicine, 30 percent of the patients had frequent angina episodes or took nitroglycerin more than twice a week to relieve the chest pain. However, 22 percent of these patients were not taking any angina-prevention medications at all, and 33 percent were being treated with only one class of anti-angina drugs.

Furthermore, of those who were taking medications, 18 percent were not taking any of them at the recommended doses, and 50 percent were taking only one class of medications at the recommended dose.

The investigators, led by Dr. Francine C. Wiest of the Veterans Affairs Puget Sound Health Care System in Seattle, Washington, point out that doctors' visits and medications are free or inexpensive for patients in the VA system, so cost is not an issue.

Instead, they say, "Physicians appeared to be underprescribing recommended antianginal medications," possibly because of concerns regarding co-existing illnesses, and drug interactions or side effects.

SOURCE: American Journal of Medicine, August 15, 2004.