Survey study to evaluate nitroglycerin and beta-blocker usage in the real-world management of angina: the cardiologists perspective

Abstract

Angina pectoris is one of the major clinical burden in India, where ischemic heart disease (IHD) is rising with an alarming rate. Management strategy for acute angina includes nitroglycerin and for chronic stable angina, β-blockers used as a first-line therapy. A multicenter, cross-sectional, questionnaire-based survey was conducted. A 35-item online MCQs was provided to Ten cardiologists, and most cardiologists identified sedentary lifestyle, hypertension and smoking as major coexisting risk factors (70%), with atherosclerosis being the leading cause of stable angina (60%). Elderly patients aged 50-70 years were considered at highest risk commonly presented with atypical symptoms (60%). For stable angina, echocardiography (50%) and exercise stress testing (40%) were preferred, whereas for vasospastic angina, provocative testing (50%) was favored. Physical exertion was the predominant trigger (80%), and BNP was considered usually normal in angina without myocardial infarction (50%). β-blockers, like metoprolol (60%) and bisoprolol (20%) were preferred as first-line therapy (90% agreement). Long-acting nitrates were majorly used in chronic stable angina (80%), whereas to prevent nitrate tolerance, 12 to 14 hours of nitrate-free interval (50%) was commonly recommended. This survey represents patient-centric and guideline-directed approach to angina pectoris management among cardiologists. There is a strong harmony on the importance of risk assessment, and proper use of non-invasive diagnostic test. Beta-blockers-particularly metoprolol and bisoprolol-along with long-acting nitrates, emerge as the most commonly preferred agents, underscoring both therapeutic familiarity and adherence to safety considerations in routine clinical practice.