Spertus John A, Jones Philip, McDonell Mary, Fan Vincent, Fihn Stephan D
Mid America Heart Institute and University of Missouri-Kansas City, Kansas City, MO 64111, USA.
Circulation. 2002 Jul 2;106(1):43-9. doi: 10.1161/01.cir.0000020688.24874.90.
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.
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).
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.
尽管患者报告的健康状况指标已被用作临床试验的终点，但在其他环境中很少使用。证明它们能独立预测冠心病门诊患者的死亡率和住院率，可能会凸显其临床价值。
本研究评估了西雅图心绞痛问卷（SAQ）的预后效用，这是一种针对冠状动脉疾病患者的疾病特异性健康状况指标。患者来自6家退伍军人事务综合内科诊所，参与了一项前瞻性队列研究。对所有报告患有冠状动脉疾病、完成SAQ且有1年随访的患者进行分析（n = 5558）。SAQ预测变量包括身体限制、心绞痛稳定性、心绞痛频率和生活质量评分。主要结局是1年全因死亡率，次要结局是急性冠状动脉综合征（ACS）住院治疗。较低的SAQ评分与死亡率和ACS入院风险增加相关。控制人口统计学和临床特征的预后模型显示，较低的SAQ身体限制评分具有显著的独立死亡风险；轻度、中度和重度限制的比值比分别为1.5、2.0和4.0，与最小限制相比（P<0.001）。轻度、中度和重度心绞痛频率的比值比分别为0.8、1.2和1.6（P = 0.078）。轻度、中度和重度心绞痛频率患者的ACS入院比值比分别为1.4、2.0和2.2（P = 0.016）。
SAQ评分与冠心病门诊患者的1年死亡率和ACS独立相关，可能在此类患者的风险分层中发挥重要作用。
