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Nitroglycerin prescription and potency in patients participating in exercise-based cardiac rehabilitation
Franklin H Zimmerman1, Arthur E Fass, Dina R Katz
1Phelps Memorial Hospital Center, Sleepy Hollow, New York, USA. FhzMD9@aol.com
Insights
Many patients with coronary heart disease do not have a nitroglycerin prescription, and those who do often have expired or subpotent medication. This highlights a critical need for improved patient and physician education regarding nitroglycerin use and storage.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Current guidelines recommend nitroglycerin for coronary heart disease patients, including those with stable angina and post-acute coronary syndromes.
- Nitroglycerin is crucial for managing myocardial ischemia symptoms but loses potency if stored improperly.
- Patients often fail to store nitroglycerin correctly, leading to subpotent medication.
Purpose of the Study:
- To determine the frequency of nitroglycerin prescriptions in patients within cardiac rehabilitation programs.
- To assess the relationship between nitroglycerin prescription practices and medication potency in these patients.
Main Methods:
- A survey was conducted over 3 months involving 617 patients across 9 cardiac rehabilitation centers.
- Patient data included cardiac diagnoses and sublingual nitroglycerin usage.
Main Results:
- 38% of surveyed patients lacked a nitroglycerin prescription.
- 23% of patients had prescriptions older than 1 year, and 15% had tablets between 6-12 months old, indicating potentially subpotent medication.
Conclusions:
- Nitroglycerin prescription is often overlooked in coronary heart disease patients.
- Many patients possess potentially subpotent nitroglycerin, necessitating education for both patients and physicians.
- Findings are significant for counseling patients in exercise-based cardiac rehabilitation programs.
Purpose:
Current guidelines call for nitroglycerin to be prescribed in patients with coronary heart disease, including those with stable angina and those recovering from acute coronary syndromes and myocardial infarction. These patients are at risk for coronary events, and nitroglycerin may be required to treat acute symptoms of myocardial ischemia. Nitroglycerin rapidly loses potency when stored improperly, compromising effectiveness. Previous studies indicate that patients frequently fail to store nitroglycerin properly. Accordingly, pharmacists routinely advise patients to renew nitroglycerin tablets every 6 months. The purpose of this study was to determine frequency of prescription of nitroglycerin and the relationship to potency in patients participating in exercise-based cardiac rehabilitation programs.
Methods:
A survey was performed over a 3-month period of 617 patients enrolled in 9 exercise-based cardiac rehabilitation centers in New York, Michigan, and Rhode Island. Patient data were evaluated according to cardiac diagnoses and the use of sublingual nitroglycerin.
Results:
A total of 38% of patients did not have a prescription for nitroglycerin. Patients with potentially subpotent nitroglycerin tablets included 23% whose prescription was older than 1 year and an additional 15% whose tablets were between 6 and 12 months old.
Conclusions:
The prescription of nitroglycerin is frequently omitted in patients with coronary heart disease. Those who are prescribed nitroglycerin frequently carry a potentially subpotent medication. Education is necessary for both patients and physicians. The findings have implications for counseling patients who are enrolled in exercise-based cardiac rehabilitation programs.
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