July 2, 2002Open Access
View Full PaperHealth Status Predicts Long-Term Outcome in Outpatients With Coronary Disease
Key Result
Lower Seattle Angina Questionnaire physical limitation scores independently predicted 1-year mortality, with severe limitation having an odds ratio of 4.0 compared to minimal limitation (P<0.001).
Key Points
- This study aims to determine if patient-reported health status measures can independently predict mortality and hospitalizations in outpatients with coronary disease.
- Prospective cohort study at 6 Veterans Affairs clinics
- Included 5558 patients with coronary artery disease who completed a Seattle Angina Questionnaire (SAQ) with 1 year follow-up
- Analyzed associations between SAQ scores and outcomes of mortality and acute coronary syndrome hospitalizations.
- Lower SAQ scores significantly correlated with increased risks of mortality and ACS admissions, P<0.001
- Odds ratios for mortality were 1.5, 2.0, and 4.0 for physical limitations compared to minimal limitation, respectively
- ACS admission odds ratios were 1.4, 2.0, and 2.2 for increasing angina frequency, P=0.016
Study Design
Type
Cohort (n=5,558)
Multicenter
Yes
Structured PICO
Do patient-reported health status measures using the Seattle Angina Questionnaire (SAQ) predict 1-year mortality and ACS hospitalization in outpatients with coronary disease?
P
Population
5,558 outpatients with coronary artery disease from 6 Veterans Affairs General Internal Medicine Clinics
I
Intervention
Seattle Angina Questionnaire (SAQ) assessment (evaluating physical limitation, angina stability, angina frequency, and quality-of-life scores)
C
Comparator
Comparison across different SAQ score severity levels (minimal, mild, moderate, severe)
O
Outcome
1-year all-cause mortalityhard clinical
Patient-reported health status using the SAQ independently predicts 1-year mortality and ACS hospitalization in outpatients with coronary disease, highlighting its value for clinical risk stratification.
Main Result
Effect estimate: OR 4.0
p-value: p=<0.001
Abstract
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.