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PubMed2007

Evaluation of the prescription and utilization patterns of statins in an Italian local health unit during the period 1994-2003.

OBJECTIVES: The prescription pattern of statins in the Local Health Unit (LHU) of Treviso (northern Italy) over a 10-year period was evaluated, with the aim of evaluating the persistence with and adherence to therapy. METHODS: Data on 21,393 subjects who received at least one prescription for statins during the period between January 1, 1994 and December 31, 2003 were retrieved from the LHU database in order to track the pharmacological history of individual patients. The data included age, sex, drug formulation, strength, number of drug packages prescribed, and prescription date. The adopted indicators for drug utilization included the Defined Daily Dose (DDD), the Received Daily Dose (RDD), and a surrogated Prescribed Daily Dose (sPDD), extrapolated from available prescription data. An Adherence to Therapy Index (ATI) was calculated from the ratio between the amount of drug actually prescribed and the amount of sPDD. Based on the ATI, patients were grouped into non-adherent, poor-adherent, and good-adherent groups. The distribution of adherence level among patient-age classes and statin-prescribed patients in primary or secondary prevention was evaluated. RESULTS: All drug-utilization indicators showed an increase in statin use over the study period in terms of both the number of prescribed patients and the sPDD. Persistence with and adherence to therapy remained low, with a 50% discontinuation rate in the first year, and persistent patients did not follow the therapy regularly. Patients in secondary prevention were the most adherent to their drug regimen, although only 41% of these had a good compliance. CONCLUSIONS: Our findings suggest an increase in statin use which is, however, accompanied by poor patient persistence with and adherence to statin therapy.

Age Factors↗
PubMed2000

Frequency of daily over-the-counter drug use and potential clinically significant over-the-counter-prescription drug interactions in the Finnish adult population.

OBJECTIVE: To explore the frequency of continuous use of over-the-counter (OTC) drugs among the Finnish adult population and the potential for harmful interactions between OTC drugs and prescribed (Rx) drugs. METHODS: Data were extracted from a 1995-1996 population-based interview survey on health care (n = 10,477, response rate 86%). The drug interaction classification system from the Swedish Drug Compendium FASS 1997 was used to identify OTC drugs likely to have clinically significant interactions with prescription drugs. Logistic regression was used to study factors related to continuous use and risks for interactions. RESULTS: Seventeen percent of the population had used OTC drugs and 15% had used OTC vitamins during the 2 days prior to the interview. Daily use of OTC drugs and of vitamins was reported by 7% and 9%, respectively. Continuous use of OTC drugs was related to older age, female gender, higher education, poor health status, long-term morbidity, psychosomatic symptoms (fatigue) and use of prescription drugs, but not to poor lifestyle. Four percent of the OTC drug users had taken drug combinations with potential for clinically significant interactions. Interactions were most common for ketoprofen (15% of ketoprofen users), ibuprofen (10%), and acetylsalicylic acid (ASA) (6%). The number of prescription drugs, long-term illness and lower education best explained the risk for interactions. CONCLUSION: Continuous use and potentially harmful Rx/ OTC drug interactions occur among OTC drug users. Further studies should be done to investigate whether potential combinations will actually lead to clinical problems. The possible interactions of non-steroidal anti-inflammatory drugs (NSAIDs) and analgesics with prescription drugs should especially be taken into account in drug information.

Adolescent↗
PubMed1997

Changes in the pattern of antidepressant use upon the introduction of the new antidepressants: a prescription database study.

OBJECTIVE: To study whether the newer antidepressants have changed the patterns of antidepressant use, and whether the claimed better adverse effect profile of the lower antidepressants is reflected in their use as monitored by a prescription database. METHOD: By means of a prescription database (OPED), the use of antidepressants from 1991 to 1993 in Odense, Denmark, was analysed. RESULTS: The 1-year prevalence of antidepressant use increased significantly from 1.60% to 2.00%, which still is below the claimed 1-year prevalence of depression of at least 5%. The increase was mainly due to a rapidly increasing use of the newer antidepressants, accompanied by a moderate decline in the use of older antidepressants (mainly tricyclic antidepressants). The patterns of antidepressant use were very polymorphic, with about 5% being on continuous use for all 3 years and groups of each 20-30% being treated with: (1) several series or (2) one series or (3) only by one prescription. The share of patients presenting only one prescription (20%) was the same for older and newer antidepressants. Likewise, the rate of shifts from older to newer antidepressants or vice versa was the same (7% vs 6%). The duration of treatment did not differ much between older and newer antidepressants. Relative to the defined daily dose (DDD), the older antidepressants were given in much lower doses (median 0.63 DDD) than the newer antidepressants (median 1.05 DDD). CONCLUSION: It is concluded that many depressed patients are still not receiving antidepressant treatment and that the claimed better adverse effect profile of the newer antidepressants was not clearly reflected in their use.

Adult↗
PubMed2006

Prescription of drugs blocking the renin-angiotensin system in Italian children.

Little is known about the prescription pattern of antihypertensive drugs for children with impaired kidney function. We have therefore documented the use of antihypertensive drugs in this patient group by evaluating the Italian pediatric population-based registry of patients with chronic kidney disease on conservative treatment (ItalKid) from 1995 to 2003. In 1995, prescriptions written for antihypertensive drugs for use by children were approximately equally divided among drugs blocking the renin-angiotensin system and calcium channel blockers (38 vs. 43% of all prescriptions), followed by beta-blockers and diuretics (15 and 4%, respectively). During subsequent years the proportion of prescriptions for drugs blocking the renin-angiotensin system increased (2003: 61%; p<0.001) and that of calcium channel blockers decreased (2003: 18%, p<0.001). In 1995, blockers of the renin-angiotensin system were prescribed, either as monotherapy or in combination, in 53% of the patients, but the relative frequency of the patients prescribed these drugs increased up to 83% in 2003 (p<0.0005). In conclusion, physicians caring for Italian children with impaired kidney function are increasingly prescribing drugs blocking the renin-angiotensin system.

Adolescent↗
PubMed1986

Using exercise respiratory measurements to compare methods of exercise prescription.

Exercise heart rate (HR) ranges based on peak HR, age-predicted maximal HR and peak oxygen consumption were compared to determine which method is most likely to result in an exercise prescription within guidelines determined from exercise respiratory measurements (upper limit--ventilatory threshold; lower limit--50% peak oxygen consumption). Exercise prescriptions based on either 80% peak HR or 70% peak measured oxygen consumption were significantly more likely to be within these guidelines (p less than 0.05) than other criteria tested; there was no significant difference between these 2 methods. Recommended exercise intensity based on 85% peak HR and 80% peak oxygen uptake resulted in a large percentage of patients with a heart rate above the ventilatory threshold (46% and 54%, respectively), whereas target HR derived from 75% peak HR and 60% peak oxygen consumption resulted in many patients with a heart rate below the lower limit (38% and 42%, respectively). Exercise prescription based on predicted maximal HR was of little value, regardless of the percentage used to determine target heart rate. The best methods identified in this study yielded an exercise intensity exceeding ventilatory threshold 15 to 20% of the time. Exercise prescription based on direct assessment of the ventilatory threshold is therefore preferred.

Adult↗
PubMed1994

Dose prescription in boron neutron capture therapy.

PURPOSE: The purpose of this paper is to address some aspects of the many considerations that need to go into a dose prescription in boron neutron capture therapy (BNCT) for brain tumors; and to describe some methods to incorporate knowledge from animal studies and other experiments into the process of dose prescription. MATERIALS AND METHODS: Previously, an algorithm to estimate the normal tissue tolerance to mixed high and low linear energy transfer (LET) radiations in BNCT was proposed. We have developed mathematical formulations and computational methods to represent this algorithm. Generalized models to fit the central axis dose rate components for an epithermal neutron field were also developed. These formulations and beam fitting models were programmed into spreadsheets to simulate two treatment techniques which are expected to be used in BCNT: a two-field bilateral scheme and a single-field treatment scheme. Parameters in these spreadsheets can be varied to represent the fractionation scheme used, the 10B microdistribution in normal tissue, and the ratio of 10B in tumor to normal tissue. Most of these factors have to be determined for a given neutron field and 10B compound combination from large animal studies. The spreadsheets have been programmed to integrate all of the treatment-related information and calculate the location along the central axis where the normal tissue tolerance is exceeded first. This information is then used to compute the maximum treatment time allowable and the maximum tumor dose that may be delivered for a given BNCT treatment. RESULTS AND CONCLUSION: The effect of different treatment variables on the treatment time and tumor dose has been shown to be very significant. It has also been shown that the location of Dmax shifts significantly, depending on some of the treatment variables--mainly the fractionation scheme used. These results further emphasize the fact that dose prescription in BNCT is very complicated and nonintuitive. The physician prescribing the dose would need to rely on some method, like the one developed here, to come up with an appropriate dose prescription.

Boron Neutron Capture Therapy↗
PubMed1996

Factors predicting change in prescription and nonprescription drug use in a community-residing black and white elderly population.

The current study identifies characteristics that predict change in use of prescription and nonprescription drugs over a period of 3 years. A modified health care services use model was applied to information obtained from a probability-based sample of black (n = 1778) and white (n = 1446) community-resident elderly, interviewed in 1986-1987 and 1989-1990. Analysis was by means of logistic and ordinary least-squares regression, with sample weights and design effects taken into account. The number of users and average number of prescription drugs used increased over the 3 years, and was best predicted by extent of prior drug use, older age, white race, poorer health, and number of health care visits. Conversely, nonprescription drug use declined significantly, and was best predicted by prior use, white race, and female gender. The reduced use of prescription drugs by blacks as compared to whites is of concern, suggesting that attention is needed to assure equitable access to prescription drugs.

Black or African American↗
PubMed2004

Higher calorie prescription improves nutrient delivery during the first 5 days of enteral nutrition.

AIMS: It is unclear whether prescribing a higher amount of calories by enteral nutrition (EN) increases actual delivery. This prospective controlled study aimed at comparing the progression of EN of two study populations with different levels of calorie prescriptions, during the first 5 days of EN. METHODS: The daily calorie prescription of group 1 (n=346) was 25 and 20 kcal/kg body weight for women <60 and > or =60 years, respectively, and 30 and 25 kcal/kg body weight for men <60 and > or =60 years, respectively. The prescription of group 2 (n=148) was 5 kcal/kg body weight higher than in group 1. Calorie intakes were expressed as percentage of resting energy expenditure (REE) and protein intakes as percentage of requirements estimated as 1.2 g/kg body weight/day. Patients were classified as <60 and > or =60 years and as medical or surgical patients. Statistical analysis was performed with ANOVA for repeated measures. RESULTS: Calorie and protein deliveries increased in both groups independently of age and ward categories (P< or =0.0001). Group 2 showed faster progressions of calorie and protein intakes than group 1 in patients altogether (P< or =0.002), > or =60 years (P< or =0.01) and in surgical patients (P< or =0.02). Differences of calorie and protein intakes between day 1 and day 5 were significantly higher in group 2 than group 1 for patients altogether (75+/-61 vs. 56+/-54% of REE; 41+/-30 vs. 31+/-/-27% of protein requirements), those over 60 years (76+/-67 of REE vs. 52+/-59 of protein requirements) and surgical patients (81+/-52 vs. 58+/-57% of REE; 44+/-27 vs. 33+/-29% of protein requirements). CONCLUSIONS: Increasing the levels of EN prescriptions improved calorie and protein deliveries. While the mean energy delivery over 5 days was sufficient to cover requirements, the protein delivery by EN was insufficient, despite our nutritional support team.

Analysis of Variance↗
PubMed2006

Medical and nonmedical use of prescription drugs among secondary school students.

PURPOSE: The main objective of this study was to assess the prevalence of medical and nonmedical use of four categories of prescription drugs (opioid, stimulant, sleeping, and sedative/anxiety medication) in a racially diverse sample of secondary public school students in the Detroit metropolitan area. A secondary objective was to examine the association between the use of four categories of prescription medications and illicit drug use and probable drug abuse. METHODS: In 2005, a Web-based survey was self-administered by 1086 secondary school students in grades seven through 12. RESULTS: The sample consisted of 54% female, 52% White, 45% African American, and 3% from other racial categories. Forty-eight percent of the sample reported no lifetime use of four categories of prescription drugs (nonusers), 31.5% reported medically prescribed use only (medical users), 17.5% reported both medical and nonmedical use (medical/nonmedical users) and 3.3% reported nonmedical use only (nonmedical users). Multivariate analyses indicated that medical/nonmedical users and nonmedical users were significantly more likely than nonusers to report illicit drug use and probable drug abuse. Medical users generally reported similar or increased odds of illicit drug use and probable drug abuse than non-users. CONCLUSIONS: These findings provide evidence that nonmedical use of prescription drugs represents a problem behavior among secondary school students.

Adolescent↗
PubMed2005

Separation of compounds interacting with liposome membrane in combined prescription of traditional Chinese medicines with immobilized liposome chromatography.

Immobilized liposome chromatography (ILC), the stationary phase of which has been regarded as a mimic biomembranes system was used to separate and analyze compounds interacting with liposome membrane in Danggui Buxue decoction, a combined prescription of traditional Chinese medicines (CPTCMs), and its compositions Radix Astragli and Radix Angelica Sinensis. More than 10 main peaks in the extract of Danggui Buxue decoction were resolved on the ILC column, suggesting that more than 10 components in the prescription have significant retention on ILC column. Ligustilide, astragaloside IV and formononetin, three main bioactive ingredients in Danggui Buxue decoction, were found to have relatively significant, while ferulic acid, another bioactive ingredient in the prescription, relatively weak retention on ILC column. Effects of the eluent pH and amount of immobilized phosphatidylcholine (PC) on separation of interactional compounds in the extract of Danggui Buxue decoction were also investigated. It was found that these two factors strongly affected the retention of some interactional compounds. In addition, the fractions partitioned with different solvents from water extract of this combined prescription were evaluated with this ILC column system.

Chromatography↗
PubMed2006

The prescription of hormone replacement therapy in Spain: differences between general practitioners and gynaecologists.

OBJECTIVES: The purpose of this study was to determine the frequency with which hormone replacement therapy (HRT) was prescribed and to identify physician-related factors associated with the prescription of HRT in Spain. STUDY DESIGN: A descriptive cross-sectional survey based on a personal interview with a structured questionnaire was conducted in April 2005 with physicians aged 25-65 years. A total of 2700 doctors were asked to participate in this prospective study (1350 GY and 1350 GP). This number included 270 gynaecologists (GY group) and 270 general practitioners (GP group). RESULTS: Only 10% of gynaecologists and 19.4% of GPs had never prescribed HRT. The reasons given for not prescribing HRT were adverse effects and the fear of cancer among GPs and adverse effects and social alarm in the GY group. Phytoestrogens were the most commonly used alternative; however, GPs were more willing to use antidepressants and benzodiazepines than GYs. The frequency of HRT prescription in symptomatic women was significantly higher among GYs. The main reasons for prescribing HRT were climacteric complaints and improvement in life quality for GYs and, climacteric complaints and the prevention of osteoporosis for GPs. Seventy-eight percent of GYs prescribing hormones referred a high degree of satisfaction with HRT, whereas only 50% of GPs expressed a similar attitude. CONCLUSIONS: Concern for HRT prescription in Spain is high. Adverse effects and the fear of cancer are negative conditioning factors in the prescription of HRT, whereas climacteric complaints, quality of life and the prevention of osteoporosis are positive conditioning factors. GYs are more willing to use HRT than GPs. This contrast may reflect the indecision of GPs regarding the preventive value of HRT.

Adult↗
PubMedDate not supplied

Prescription drug formularies in managed care: concerns for the elderly population.

Prescription drug formularies are a key element in the rapidly growing trend of prescription drug benefit management. The use of formularies can increase the quality of prescribing and reduce the costs of prescription drug therapy. This is particularly important to older Americans, who represent about 13% of the population but consume roughly one third of the drugs prescribed in the United States. However, the question of whether the use of formularies affects patient access to pharmaceuticals has not been analyzed sufficiently. This paper identifies benefits and risks to older Americans from the use of prescription drug formularies by third-party payers, analyzes the evidence of those benefits and risks, and proposes areas for future research. An extensive review and synthesis of the literature were performed, focusing on three aspects of drug formulary design: (1) the extent to which health maintenance organizations and insurers consider consumer interests when using formularies; (2) the extent to which formulary design is affected by clinical and economic considerations; and (3) the impact of formularies on the quality of drug care received. Safeguards to guarantee that economic considerations of drug benefit managers do not restrict access to needed drugs are insufficient. Alternatively, no evidence to date shows that the use of formularies adversely affects patients' access to pharmaceutical care. More research is required to understand the process of drug formulary development and the extent to which different formulary recommendations impede on physicians' ability to provide high-quality care.

Aged↗
PubMedDate not supplied

[Factors associated with drug prescription].

The ascertainment of the factors that directly or indirectly influence the prescription of medication is a starting point to set up different strategies focused on the improvement of the utilization of medications. The purpose of this work is to assess which factors, closely related with physicians, with the population they cover, as well as with the health care infrastructure of our "Area of Management" (health district), are significantly associated with the prescription of medication, as well as to ascertain if there is, in our environment, a defined profile of those physicians having higher prescription rates. Using the Institut Català de la Salut (ICS) database, and through with the use linear multiple regression, it can be shown that: a) the expense due to medications is higher in those sectors having a larger number of physicians per 1,000 inhabitants; and b) a profile of large prescriptions cannot be established based on the variables selected in this study.

Adult↗
PubMed1999

How often do parenteral nutrition prescriptions for the newborn need to be individualized?

BACKGROUND: Parenteral nutrition is commonly given in the newborn period to premature infants or those with gastrointestinal disorders. Computer-assisted prescribing is widely used, with prescriptions for each patient being varied on a daily basis. It has previously been suggested that 'individualization' of feeds may have little clinical benefit whilst increasing pharmacy workload and costs. However, the scope for use of standard feed solutions as an alternative remains uncertain. METHODS: To assess the potential for using standardized pre-mixed feeds we prospectively reviewed 148 computer assisted prescriptions for newborn infants in order to establish how often the prescribing clinician adhered to the computer protocol, and the reason for modification when this occurred. RESULTS: Only one-fifth of feeds were based strictly on the computer recommendation with no, or minimal, modification. However, many of the deviations in the other four-fifths of feed prescriptions reflected a routine use of higher carbohydrate, sodium and phosphate intakes implying that a higher proportion of feeds could be 'standardized' if the computer regimens were modified to reflect current nutritional practices on the unit. CONCLUSIONS: This study suggests that the introduction of standard PN feeds could considerably reduce the use of computer assisted individualized PN prescriptions on the neonatal unit. The practical implications of such a system for pharmacy and the potential cost benefits deserve further investigation.

Decision Making, Computer-Assisted↗
PubMed2000

[High prevalence of long-term domiciliary oxygen therapy with a low percentage of inappropriate prescription in the Madrid health care area. Evaluation of the correct use].

UNLABELLED: The efficacy of long-term domiciliary oxygen therapy (DOT) has been confirmed in patients who comply with guidelines; however, the prevalence in different populations varies greatly although no satisfactory explanation has been found for this. OBJECTIVES: To assess the prevalence of inappropriate use of DOT in the health care area of the Community of Madrid, where demographic and health care features are well-defined. MATERIAL AND METHODS: Descriptive, transversal population study enrolling all patients with DOT in our health care area over a period of one year (May 1995 to Mayo 1995). Inappropriate use was defined as characterized by at least one of the following conditions: inappropriate prescription, poor compliance or continued smoking. RESULTS: The total number of patients was 860, the prevalence of DOT use being 178.3 per 100,000 inhabitants for the period. Ninety-three refused to participate. Nearly half the patients ha been using oxygen therapy for over two years. Seventy percent were followed by pneumologists. Seventy-four percent were men, with a mean age of 70 +/- 9 yr. Criteria for prescription were not followed in 9.7% of the cases. Chronic obstructive pulmonary disease was the reason for prescribing DOT in 59.7%. Use was appropriate in 719 cases. Use was inappropriate in 337 (46.9%), related to poor compliance in 60.5%, current smoking in 11%, and inappropriate prescription in 5.6% and for more than one criterion in 22.8%. CONCLUSIONS: The prevalence of DOT use in our health care area is very high. The percentage of inappropriate use is high, although similar to that of other populations, and highly related to poor compliance. The percentage of inappropriate prescription is low. Possible reasons for the high prevalence are discussed.

Adolescent↗
PubMed2001

Exercise testing in cardiac rehabilitation. Exercise prescription and beyond.

The prescription of exercise, either as a part of a formal exercise training program or as a means to increase physical activity in general, has been and will remain a primary component of cardiac rehabilitation and secondary prevention programming. Wherever possible, this prescription should be based on a recent exercise test that documents the cardiac patient's functional capacity, cardiac and hemodynamic responses to exercise, and signs and symptoms associated with exertion. Clearly the prescription of exercise and suggestions for increasing levels of physical activity must be based on accepted principles of exercise physiology and expected training responses. Nonetheless, the art of exercise prescription should guarantee flexible methodologies to meet the specific needs of each individual patient. Although the patient must accept ultimate responsibility for participation, the clinician bears the burden of continually attempting to reinforce the importance of increasing caloric expenditure and motivating patients to initiate and commit to long-term participation in a safe and appropriately designed program of exercise and increasing physical activity.

Cardiac Rehabilitation↗
PubMed2003

Can primary care doctors prescribe exercise to improve fitness? The Step Test Exercise Prescription (STEP) project.

BACKGROUND: Sedentary lifestyle is associated with adverse health outcomes. Available evidence suggests that, despite positive attitudes toward regular exercise in promoting a healthy lifestyle, few physicians actually prescribe exercise for their patients. Barriers include lack of skills and standard office instruments. Because primary care physicians have regular contact with a large proportion of the population, the impact of preventive health interventions may be great. OBJECTIVES: To determine the effect of an exercise prescription instrument (i.e., Step Test Exercise Prescription [STEP]), compared to usual-care exercise counseling delivered by primary care doctors on fitness and exercise self-efficacy among elderly community-dwelling patients. DESIGN: Randomized controlled trial; baseline assessment and intervention delivery with postintervention follow-up at 3, 6, and 12 months. SETTING: Four large (>5000 active patient files) academic, primary care practices: three in urban settings and one in a rural setting, each with four primary care physicians; two clinics provided the STEP intervention and two provided usual care control. PARTICIPANTS: A total of 284 healthy community-dwelling patients (72 per clinic) aged >65 years were recruited in 1998-1999. INTERVENTION: STEP included exercise counseling and prescription of an exercise training heart rate. MAIN OUTCOME MEASURES: The primary outcome measure was aerobic fitness (VO(2max)). Secondary outcomes included predicted VO(2max) from the STEP test, exercise self-efficacy (ESE), and clinical anthropometric parameters. RESULTS: A total of 241 subjects (131 intervention, 110 control) completed the trial. VO(2max) was significantly increased in the STEP intervention group (11%; 21.3 to 24ml/kg/min) compared to the control group (4%; 22 to 23ml/kg/min) over 6 months (p <0.001), and 14% (21.3 to 24.9ml/kg/min) and 3% (22.1 to 22.8ml/kg/min), respectively, at 12 months (p <0.001). A similar significant increase in ESE (32%; 4.6 vs 6.8) was observed for the STEP group compared to the control group (22%; 4.2 vs 5.4) at 12 months (p < 0.001). Systolic blood pressure decreased 7.3% and body mass index decreased 7.4% in the STEP group, with no significant change in the control group (p <0.05). Exercise counseling time was significantly (p <0.02) longer in the STEP (11.7+/-3.0 min) compared to the control group (7.1+/-7.0 min), but more (p <0.05) subjects completed > or =80% of available exercise opportunities in the STEP group. CONCLUSIONS: Primary care physicians can improve fitness and exercise confidence of their elderly patients using a tailored exercise prescription (e.g., STEP). Further, STEP appears to maintain benefits to 12 months and may improve exercise adherence. Future study should determine the impact of combining cognitive/behavior change strategies with STEP.

Aged↗
PubMed2002

Prescription of anti-anginal drugs in relation to exercise tests and coronary angiography. A 1-year population-based study of two Danish counties.

BACKGROUND: The cardiac diagnostic examination activity in a population should ideally mirror age and gender characteristics of the prevalence of ischemic heart disease. In this study, the prescription of anti-anginal drugs in relation to morbidity and mortality brought on by ischemic heart disease, and in relation to exercise tests and coronary angiography, is analyzed. METHODS: The study population comprised two Danish counties with a total of 896,954 inhabitants. We obtained data on all prescriptions of nitrates, adrenergic beta-antagonists, and calcium channel blockers from regional pharmaceutical registers. Data on all patients who took an exercise test or underwent coronary angiography were derived from regional health authority registers. Data on ischemic heart mortality and on the incidence of myocardial infarction were gathered from the national register of causes of death and hospital registers. RESULTS: Only patients receiving nitrates had an age and gender profile matching that of those who died from ischemic heart disease or who suffered from myocardial infarction (correlation coefficients 0.95-0.99). Judging from the prescription of nitrates, relatively few elderly patients, especially women older than 60-69 years, were referred for a cardiac examination. CONCLUSIONS: The prescription of nitrates seems useful as a surrogate marker for ischemic heart disease. Elderly patients, especially women, seem to be treated with anti-anginal medication without any diagnostic evaluation.

Journal Article↗