Are patients suffering from stable angina receiving optimal medical treatment

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 exam ined prescription profiles for a sample of patients aged greater than or eq ual to 65 years with stable angina, to compare the profiles to local guidel ines and to explore the determinants of these profiles, in a cross-sectiona l study. We identified 11 141 individuals from the Quebec provincial out-pa tient pharmaceutical database for the period 1 lune 1996 to 31 May 1997, an d examined the percentage of these patients with and without associated co- morbidities receiving antiplatelet, beta-blocker and lipid-lowering medicat ions. We used hierarchical modelling to examine the role of patient and phy sician characteristics in explaining the variation in the use of these medi cations. Calcium-channel blockers were the class of anti-ischaemic drugs mo st prescribed (63%). Beta-blockers were prescribed in 52.1% of patients. An tiplatelet and lipid-lowering drugs were prescribed to 56.8% and 32.6%, res pectively. increasing age and female gender made patients less likely to be prescribed these treatments. General practitioners were less likely than c ardiologists to prescribe beta-blockers and lipid-lowering drugs (OR 0.79, C1 95% 0.68-0.91 and OR 0.77, CI 95% 0.66-0.91,respectively). There is a ge neral under-use of antiplatelet, beta-blocker and lipid-lowering medication s in the treatment of stable angina pectoris patients, ical modelling to ex amine the role of patient and possibly leading to adverse patient outcomes.