Audit of primary care angina management in Sandwell, England

Abstract

This audit aimed to assess the identification and treatment of coronary risk factors, lifestyle advice given and use of drug therapy, among patients with angina in Sandwell. It was designed to help general practices evaluate their angina management, and highlight areas where practice could be improved. Criteria were based on Sandwell's published angina audit and local clinical guidelines. Each participating practice was asked to identify all patients with angina, from which a 10% sample was randomly selected. The notes of each selected patient were examined for evidence showing whether agreed standards of care had been achieved. Fifteen practices took part, and contributed data on a total of 358 patients. Of patients without contraindications, 66.5% were taking aspirin, 62.1% were prescribed short-acting nitrates and 58.4% were prescribed beta-blockers. Non-white patients were significantly less likely to receive short-acting nitrates (p < 0.001) and women were significantly less likely to receive beta-blockers (p < 0.01). A total of 83.5% of patients had received smoking cessation advice, 75.1% had weight advice, 75.1% were advised about alcohol use and 64.5% about exercise. Overall, 77.4% had a blood pressure check within the previous twelve months, 40.5% had their cholesterol measured and 33.5% had their blood glucose measured. Non-white patients were significantly less likely to receive smoking cessation, weight, exercise and alcohol advice and were less likely to have their blood pressure checked (all p < 0.0001). Patients aged 65 and over were significantly less likely to receive a cholesterol check (p < 0.0001). None of the auditable standards were actually met. This study shows that there is considerable scope to improve the management of angina patients, with particular regard to aspirin. We recommend that practices develop systems to ensure that the appropriate treatment, advice and checks are given to all patients with angina, paying particular attention to those from ethnic minority backgrounds.

Sublingual Nitroglycerin Practices in Patients With Coronary Artery Disease in Australia

“…8Y15 Most patients identified correct symptoms to treat with SLNTG, and no incorrect symptoms were included, despite concerns raised in previous studies. 11,12 Patients were also well informed regarding the administration methods, dosage, timing, and sequence and that the SLNTG could expire. 9,13,14 However, notable knowledge deficits occurred in relation to the use of SLNTG to prevent angina symptoms in stable angina, which has been noted in the literature.…”

“…8,9,13 Patients may also overgeneralize the symptoms they treat, using SLNTG inappropriately for multiple symptoms such as palpitations or dizziness. 11,12 On the other hand, most patients are reported to be aware of important safety requirements such as dosing and body position, 9,11,13,14 but are less aware of other safety requirements such as storage, prophylactic use, and when to seek medical assistance. 8,11,14,15 Several limitations were evident in the literature related to SLNTG knowledge in CAD patients.…”

“…11,12 On the other hand, most patients are reported to be aware of important safety requirements such as dosing and body position, 9,11,13,14 but are less aware of other safety requirements such as storage, prophylactic use, and when to seek medical assistance. 8,11,14,15 Several limitations were evident in the literature related to SLNTG knowledge in CAD patients. These limitations include lack of investigation of patients' knowledge of the role of SLNTG in relation to a chest-pain action plan, including appropriate responses when chest discomfort is unrelieved such as calling an ambulance.…”

Health risks in south Asian men: heightening awareness

“…31 Ethnic minority patients are significantly less likely to receive advice on smoking cessation. 32 Like the white European population, studies find that The introduction of pay-for-performance incentives in UK primary care has been shown to be associated with better and more equitable management of CHD across ethnic groups, 36 and general practices with a higher proportion of south Asian patients have been reported as having higher rates of coronary angiography. 37 In populations already selected for coronary angiography, south Asians were also not inequitably managed in terms of prescription medication, 38 while the prognosis of coronary disease is equitable when comparing south Asians and white patients who have presented with angina.…”

Application of NHG guidelines in patients referred for stable chest pain syndromes

“…4 However, guidelines only have limited impact on (changing) a physician's routine practice. 5,6 Studies in other countries have shown that the medical care of patients with stable angina is often suboptimal [7][8][9][10][11] and it seems legitimate to assume that the situation is not different in the Netherlands. A Dutch study, for example, showed that only 51% of patients with AP diagnosed by GPs were prescribed aspirin.…”