Health Status Predicts Long-Term Outcome in Outpatients With Coronary Disease

Spertus JA, Jones P, McDonell M, Fihn SD

Circulation 106: 43-49, 2002.

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Background

Although patient-reported health status measures have been used as endpoints 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 one year of follow-up were analyzed (n=5,558). SAQ predictor variables were the physical limitation, angina stability, angina frequency and quality of life scores. The primary outcome was one-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 (p = 0.016).

Conclusion

SAQ scores are independently associated with 1-year mortality and acute coronary syndromes among outpatients with coronary disease and may serve a valuable role in the risk stratification of such patients.