Angina Symptoms Are Associated With Mortality in Older Women With Ischemic Heart Disease

BACKGROUND: Angina symptoms have been reported to predict mortality in men. The aim of this study was to investigate the association between angina symptoms and mortality in women. METHODS AND RESULTS: In 2004, 873 older participants in the Australian Longitudinal Study on Women's Health with self-reported ischemic heart disease participated in a nested substudy. Women were 77 to 83 years of age; 165 (19%) died during the 4.5-year follow-up. Angina symptoms were established with Seattle Angina Questionnaire (SAQ) scores for physical limitation, angina frequency, angina stability, and disease perception. Proportional hazards modeling was used to examine the relationship of SAQ score differences with mortality. Physical limitation scores were associated with mortality, with hazard ratios of 1.1, 1.9, and 3.4 for mild, moderate, and severe versus minimal limitations, respectively (P<0.001). Angina frequency scores were also associated with death, with hazard ratios of 1.2, 1.2, and 4.8 for mild, moderate, and severe versus minimal angina frequency, respectively (P<0.001). Age (hazard ratio 1.1, 95% confidence interval 1.0 to 1.2), pulmonary disease (hazard ratio 1.6, 95% confidence interval 1.2 to 2.3), and kidney disease (hazard ratio 1.7, 95% confidence interval 1.1 to 2.5) were statistically significantly associated with mortality in a multivariable model of clinical predictors. In a combined model with SAQ scores and clinical predictors, SAQ scores for physical limitation and angina stability remained statistically significantly associated with mortality. CONCLUSIONS: In older women with ischemic heart disease, angina symptoms assessed by use of SAQ scores for physical limitations and angina frequency were associated with mortality; SAQ scores may therefore prove to be a useful tool for risk assessment in this patient group.