Circulation. 2002;106:43-49
Published online before print June 17, 2002, doi: 10.1161/01.CIR.0000020688.24874.90
Published online before print June 17, 2002, doi: 10.1161/01.CIR.0000020688.24874.90
(Circulation. 2002;106:43.)
© 2002 American Heart Association, Inc.
Clinical Investigation and Reports |
Health Status Predicts Long-Term Outcome in Outpatients With Coronary Disease
From Mid America Heart Institute and University of Missouri–Kansas City (J.A.S., P.J.); Health Services Research and Development Center of Excellence, VA Puget Sound Health Care System, Seattle (M.M., V.F., S.D.F.); and the Department of Medicine, University of Washington, Seattle (V.F., S.D.F.).
Correspondence to John Spertus MD, MPH, Mid America Heart Institute, 4401 Wornall Rd, Kansas City, MO 64111. E-mail spertusj{at}umkc.edu
Background— Although patient-reported health status measures have been used as end points in clinical trials, they are rarely used in other settings. Demonstrating that they independently predict mortality and hospitalizations among outpatients with coronary disease could emphasize their clinical value.
Methods and Results— This study evaluated the prognostic utility of the Seattle Angina Questionnaire (SAQ), a disease-specific health status measure for patients with coronary artery disease. Patients were enrolled in a prospective cohort study from 6 Veterans Affairs General Internal Medicine Clinics. All patients reporting coronary artery disease who completed a SAQ and had 1 year of follow-up were analyzed (n=5558). SAQ predictor variables were the physical limitation, angina stability, angina frequency, and quality-of-life scores. The primary outcome was 1-year all-cause mortality, and a secondary outcome was hospitalization for acute coronary syndrome (ACS). Lower SAQ scores were associated with increased risks of mortality and ACS admissions. Prognostic models controlling for demographic and clinical characteristics demonstrated significant independent mortality risk with lower SAQ physical limitation scores; odds ratios for mild, moderate, and severe limitation were 1.5, 2.0, and 4.0 versus minimal limitation (P<0.001). Odds ratios for mild, moderate, and severe angina frequency were 0.8, 1.2, and 1.6 (P=0.078). The odds ratios for ACS admission among those with mild, moderate, and severe angina frequency were 1.4, 2.0, and 2.2, respectively (P=0.016).
Conclusions— SAQ scores are independently associated with 1-year mortality and ACS among outpatients with coronary disease and may serve a valuable role in the risk stratification of such patients.
Key Words: mortality • coronary disease • angina • Seattle Angina Questionnaire • risk factors
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|
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|
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|
|
|
|
|
|
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|
|
|
|
 |
|
 M. Jones, G. Rait, J. Falconer, and G. Feder Systematic review: prognosis of angina in primary care Fam. Pract., October 1, 2006; 23(5): 520 - 528. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
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|
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|
|
|
|
 |
|
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|
|
|
|
 |
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
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|
|
|
|
|
|
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|
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|
|
|
|
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|
|
|
|
 |
|
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|
|
|
|
 |
|
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|
|
|
|
|
|
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|
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|
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|
|
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|
|
|
|
|
|
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|
|
|
|
 |
|
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|
|
|
|
|
|
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|
|
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