| Background. The correct application of organic nitrates for acute coronary syndromes (ACS) remains incompletely understood.; Objective. To examine long-acting (LA) nitrate use for ACS. Design. Postal survey.; Participants. Internists, cardiologists, and emergency physicians in Canada.; Measurements. Physicians' ratings of the decision to use LA-nitrates for 13 different ACS variables, and in three clinical vignettes.; Results. The response rate was 51.6%. Important determinants of LA-nitrate use were pulmonary edema, angina at rest with ECG changes, and ongoing rest pain. Nitrate use increased from 33% to 87% for the low and high-risk vignettes respectively. 34% of nitrate users selected a non-tolerance producing (intermittent) dosing regimen for the high-risk vignette. There were no differences in nitrate use or dosing regimen between specialists. Risk assessment was the most important predictor of LA-nitrate use by multivariable analysis.; Conclusions. LA-nitrates are frequently used for patients with ACS and many clinicians use intermittent dosing that maybe inappropriate. |
