Trends in the post-hospitalization medical treatment of unstable angina pectoris: 1990 to 1995

This study provides data on post-hospitalization medication treatment trend s for unstable angina between 1990 and 1995, We conducted an observational cohort study at the Veterans Affairs Puget Sound Health Care System (VAPSHC S), Computerized records of hospital discharges and cardiac catheterization s were used to identify unstable angina diagnoses among veterans between 19 90 and 1995. Discharge medications issued within 90 days after discharge we re ascertained from computerized outpatient pharmacy records, Of the 1,100 veterans discharged with unstable angina, 885 (80%) filled a prescription t hrough the VAPSHCS within 90 days after discharge. Neither use of aspirin n or use of beta blockers increased between 1990 and 1995: overall use averag ed 76% for aspirin (78% of those without potential contraindications) and 3 2% for beta blockers (36% of those without potential contraindications). Us e of non-dihydropyridine calcium antagonists-primarily diltiazem-decreased from 57% to 40% (p <0.01), whereas use of dihydropyridine calcium antagonis ts increased from 12% to 26% (p <0.01), Thus, pharmacy records indicated th at aspirin use was high although it was,lower than expected, possibly due t o ready availability outside the VAPSHCS pharmacy, The low frequency of bet a-blocker use and the increasing reliance on dihydropyridine calcium antago nists through 1995 to treat unstable angina may be an opportunity to improv e veteran care according to Agency for Health Care Policy Research recommen dations. (C) 1999 by Excerpta Medica, Inc.