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Temporal trends in the medical treat...

Smith, Nicholas Lannon.

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Temporal trends in the medical treatment of unstable angina: 1990-1995, and, Health outcomes associated with beta-blocker and diltiazem treatment of unstable angina.

Record Type:	Electronic resources : Monograph/item
Title/Author:	Temporal trends in the medical treatment of unstable angina: 1990-1995, and, Health outcomes associated with beta-blocker and diltiazem treatment of unstable angina./
Author:	Smith, Nicholas Lannon.
Description:	77 p.
Notes:	Source: Dissertation Abstracts International, Volume: 58-08, Section: B, page: 4132.
Contained By:	Dissertation Abstracts International58-08B.
Subject:	Health Sciences, Medicine and Surgery. -
Online resource:	http://pqdd.sinica.edu.tw/twdaoapp/servlet/advanced?query=9807032
ISBN:	0591572354

Temporal trends in the medical treatment of unstable angina: 1990-1995, and, Health outcomes associated with beta-blocker and diltiazem treatment of unstable angina.
Smith, Nicholas Lannon.

Temporal trends in the medical treatment of unstable angina: 1990-1995, and, Health outcomes associated with beta-blocker and diltiazem treatment of unstable angina. - 77 p.

Source: Dissertation Abstracts International, Volume: 58-08, Section: B, page: 4132.

Thesis (Ph.D.)--University of Washington, 1997.

This study examined trends in the medical treatment of unstable angina and compared health outcomes associated with beta-blocker and diltiazem treatments. Eligible veterans were discharged from the Seattle Division of the Veterans Affairs Puget Sound Health Care System (VAPSHCS) between October 1, 1990, and September 30, 1995, after having had a diagnosis of unstable angina. Discharge medications were ascertained from computerized VAPSHCS outpatient pharmacy records. Veterans medical records were used to ascertain clinical covariates. Follow-up death and coronary artery disease (CAD) re-hospitalization data were collected through December 1, 1995. Chi-square test for trend tested the change in use of aspirin, beta-blockers, and calcium-antagonists over time. Proportional hazards regression compared survival of diltiazem to beta-blocker users, controlling for patient characteristics. Neither the use of aspirin nor beta-blockers increased over time and overall use averaged 76% for aspirin and 32% for beta-blockers. The use of non-dihydropyridine calcium-channel blockers decreased 17% to 40% (p

ISBN: 0591572354Subjects--Topical Terms:

1017756
Health Sciences, Medicine and Surgery.

Temporal trends in the medical treatment of unstable angina: 1990-1995, and, Health outcomes associated with beta-blocker and diltiazem treatment of unstable angina.
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100 1 $a Smith, Nicholas Lannon. $3 1925551
245 1 0 $a Temporal trends in the medical treatment of unstable angina: 1990-1995, and, Health outcomes associated with beta-blocker and diltiazem treatment of unstable angina.
300 $a 77 p.
500 $a Source: Dissertation Abstracts International, Volume: 58-08, Section: B, page: 4132.
500 $a Chairperson: Gayle E. Reiber.
502 $a Thesis (Ph.D.)--University of Washington, 1997.
520 $a This study examined trends in the medical treatment of unstable angina and compared health outcomes associated with beta-blocker and diltiazem treatments. Eligible veterans were discharged from the Seattle Division of the Veterans Affairs Puget Sound Health Care System (VAPSHCS) between October 1, 1990, and September 30, 1995, after having had a diagnosis of unstable angina. Discharge medications were ascertained from computerized VAPSHCS outpatient pharmacy records. Veterans medical records were used to ascertain clinical covariates. Follow-up death and coronary artery disease (CAD) re-hospitalization data were collected through December 1, 1995. Chi-square test for trend tested the change in use of aspirin, beta-blockers, and calcium-antagonists over time. Proportional hazards regression compared survival of diltiazem to beta-blocker users, controlling for patient characteristics. Neither the use of aspirin nor beta-blockers increased over time and overall use averaged 76% for aspirin and 32% for beta-blockers. The use of non-dihydropyridine calcium-channel blockers decreased 17% to 40% (p $< $. 01) while the use of dihydropyridines increased 14% to 26% (p $< $. 01). Two hundred and forty-six veterans (22%) were using beta-blocker or diltiazem monotherapy at discharge. There were 43 (17%) deaths during an average follow-up of 39 months. In unadjusted analyses, diltiazem was associated with a non-significant two-fold increase in risk of death compared to beta-blockers (hazards ratio (HR): 2.0; 95% confidence interval (CI): 0.82-4.6). After adjustment, the risk was attenuated (HR: 1.2; 95% CI: 0.47-2.9). Among Washington State veterans (n = 208), there were 136 (67%) deaths or CAD re-hospitalizations during follow-up. In unadjusted models, diltiazem was associated with a 90% increase in CAD re-hospitalization or mortality compared to beta blockers (HR: 1.9; 95% CI: 1.2-2.9). After adjustment, the association was diminished to a 40% increase (HR: 1.4; 95% CI: 0.78-2.5). In conclusion, the low use of beta-blockers and the increasing reliance upon dihydropyridines to treat unstable angina represents less than optimal therapy according to current treatment guidelines. We found no survival benefit of diltiazem over beta-blocker treatment for unstable angina in this cohort of veterans. There was a suggestion that beta-blockers may be associated with a reduced risk of CAD re-hospitalizations compared to diltiazem.
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773 0 $t Dissertation Abstracts International $g 58-08B.
790 1 0 $a Reiber, Gayle E., $e advisor
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