Defining the proper role for self-administered sublingual nitroglycerin. A survey of physicians and patients

Evaluation of a brief educational intervention to improve knowledge of sublingual nitroglycerin in cardiac rehabilitation patients

OBJECTIVE

This study aimed to evaluate the impact of a brief educational intervention delivered in cardiac rehabilitation (CR) on patients' knowledge of sublingual nitroglycerin (SLN).

METHODS

Patients (n=86) commencing CR were provided with a brief educational intervention tailored to deficits identified in an assessment of SLN knowledge using the Sublingual Nitroglycerin Questionnaire, with reassessment at the end of program completion (6-8 weeks).

RESULTS

The mean age of patients was 64.95 years (standard deviation (SD) 10.87); 74% were male, 78% were married and 60% had not completed high school. Most (70%) had no prior coronary heart disease (CHD) history and 80% had been referred to CR following percutaneous coronary intervention. SLN knowledge scores increased from baseline to outcome. Patients were significantly more likely to know: the name of their SLN medication (11% increase, p=0.001), the recommended timing between doses (29% increase, p=0.02), the maximum number of doses (27% increase, p=0.005), to have SLN on their person at the time of the interview (25% increase, p<0.001) and to know the interaction between SLN and sildenafil (36% increase, p=0.001). The independent predictors of SLN knowledge included having better knowledge at baseline (β=0.28) and having consulted a general practitioner post discharge and before commencing CR (β=1.48).

CONCLUSION

A brief standardised knowledge intervention, individually tailored to identified deficits in a knowledge screen and delivered during CR, shows promise for improving patient knowledge of SLNs. The role of general practitioners in delivering medication education needs further investigation.

Knowledge and use of sublingual nitroglycerin and cardiac-related quality of life in patients with chronic stable angina

Relationships among sublingual nitroglycerin (SLN) knowledge and use, general aspects of angina self-management, and quality of life were investigated in 95 patients with angina (age 63 +/-11 years). Quality of life was measured using a reliable and valid questionnaire, the Seattle Angina Questionnaire. Older age (p = 0. 04), male gender (p = 0.0001), more recent diagnosis with coronary artery disease (p = 0.02), and distant recall of SLN instruction (p = 0.02) predicted poorer SLN knowledge (R(2) = 0.26, p < 0.001). Male gender (p = 0.001) predicted more difficulty with SLN use (R(2) = 0.15, p = 0.005). A "bad" experience with SLN was associated with poorer quality of life (r = -22, p = 0.047). Sixty-five percent lacked knowledge about using SLN to prevent symptoms and 32.6% took SLN for symptoms other than chest pain. Findings support the need for more frequent reinforcement of patient education, especially in the areas of preventive use of SLN and side effect management.