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.