Objective: To describe the routine management of patients with chronic
stable angina by GPs in Northern Ireland and the factors which they p
erceived affected the success of medical therapy. Design: A questionna
ire survey of all general practitioners in Northern Ireland (n = 962).
Setting: A survey conducted collaboratively by the Departments of Pub
lic Health Medicine in each of the four Health Boards in the province.
Total population served, 1.5 million. Main outcome measures: The rela
tionship between the perceived reasons for medical treatment failure a
nd the stated referral and prescribing practice of the GPs. Results: A
total of 541 Gps replied; the response rate was 56%. The two most imp
ortant reasons given for the perceived failure of medical therapy were
(i) underlying disease progression and (ii) an adverse patient lifest
yle such as smoking or obesity (cited as of primary importance by (i)
264 and (ii) 225 doctors respectively). The ranking differed significa
ntly according to the doctor's propensity to prescribe triple therapy,
with those doctors in the highest tertile of this distribution being
less likely to cite the patient's lifestyle as a primary reason for tr
eatment failure (chi-squared=6.7, d.f.=2, P=0.035) and more likely to
cite underlying disease progression as a primary reason (chi-square=7.
0, d.f.=2, p=0.031). The overall ranking of the primary reasons for re
ferral differed significantly according to the proportion of patients
given a trial of triple therapy and to the doctor's propensity to refe
r. Doctors who had given a greater proportion of their patients at lea
st a trial of triple therapy (in the highest tertile of the distributi
on) were more likely to cite the need for revascularisation assessment
as the primary reason (chi-square=12.5, d.f.=2, P=0.0019). On the oth
er hand, the need for further advice on medical therapy was generally
ranked higher by those doctors who had given fewer of their patients a
t least a trial of triple therapy (chi-square=7.3, d.f.=2, P=0.027). G
Ps who had referred fewer of their new patients to hospital were more
likely to be those doctors with fewer patients given at least a trial
of triple therapy. Doctors with a greater percentage of their patients
managed primarily by a hospital specialist tended to have more who ha
d had a trial of triple therapy for their symptoms. Conclusions: The r
esults suggest the need for clearer definition for GPs of the place of
revascularisation and of medical therapy for patients with stable ang
ina.