[Nitrate prescriptions in primary care--are we over-prescribing? A pilot intervention]

Nitrates vasodilate coronary arteries that are already compensatory dilated due to ischemia and increase the coronary blood flow. In the short term, the use of nitrates, after myocardial infraction has advantages, while prolonged use can even be associated with an increase in sudden death.

To characterize patients treated with nitrates in a primary care clinic and examine whether a lecture concerning benefits and harms of nitrates will cause discontinuation of their use.

An interventional study performed in one primary care clinic. The clinic physician attended a Lecture on nitrates, including benefits and harms. The outcome measure was the number of patients that stopped using nitrates. The last stage included interviews with patients concerning their symptoms, six months after intervention.

Of the 8794 patients treated in the clinic, 284 (3.2%) were treated with nitrates; 166 of the patients were using nitrates on a regular basis; 75 (26.4%) of those using nitrates did not have a clinical indication for chronic use. Nitrates were discontinued in 40 patients (53.5% of those taking nitrates with no indication). Of the patients who stopped taking nitrates, 26 (65%) remained asymptomatic after 6 months.

We found that there was over-prescription of nitrates and that the family physician, based on anamnesis and data from the medical file, can stop nitrate treatment to about 10% of these patients without any significant harm.

A family physician can stop nitrate treatment based on anamnesis and data from the medical file.