Schopfer David W, Beatty Alexis L, Meyer Craig S, Whooley Mary A
Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, Maryland.
Department of Medicine, University of California, San Francisco, SF, CA.
Am J Cardiol. 2022 Feb 1;164:1-6. doi: 10.1016/j.amjcard.2021.10.037. Epub 2021 Nov 24.
Angina is a common symptom in patients with coronary artery disease (CAD); however, its impact on patients' quality of life over time is not well understood. We sought to determine the longitudinal association of angina frequency with quality of life and functional status over a 5-year period. We used data from the Heart and Soul Study, a prospective cohort study of 1,023 outpatients with stable CAD. Participants completed the Seattle Angina Questionnaire (SAQ) at baseline and annually for 5 years. We evaluated the population effect of angina frequency on disease-specific quality of life (SAQ Disease Perception), physical function (SAQ Physical Limitation), perceived overall health, and overall quality of life, with adjusted models. We evaluated these associations within the same year and with a time-lagged association between angina and quality of life reported 1 year later. Generalized estimating equation models were used to account for repeated measures and within-subject correlation of responses. Over 5 years of follow-up, patients with daily or weekly angina symptoms had lower quality of life scores (52 vs 89, p <0.001) and greater physical limitation (61 vs 86, p <0.001) after adjustment. Compared with patients with daily or weekly angina symptoms, those with no angina symptoms had 2-fold greater odds of better quality of life (odds ratio 2.39, 95% confidence interval 1.76 to 3.25) and 5-fold greater odds of better perceived overall health (odds ratio 5.45, 95% confidence interval 3.85 to 7.73). In conclusion, angina frequency is strongly associated with quality of life and physical function in patients with CAD. Even after modeling to adjust for both clinical risk factors and repeated measures within subjects, we found that less frequent angina symptoms were associated with better quality of life.
心绞痛是冠状动脉疾病（CAD）患者的常见症状；然而，随着时间推移其对患者生活质量的影响尚未得到充分了解。我们试图确定5年内心绞痛发作频率与生活质量和功能状态之间的纵向关联。我们使用了来自心脏与灵魂研究的数据，这是一项对1023例稳定CAD门诊患者进行的前瞻性队列研究。参与者在基线时以及之后连续5年每年完成西雅图心绞痛问卷（SAQ）。我们通过调整模型评估心绞痛发作频率对疾病特异性生活质量（SAQ疾病认知）、身体功能（SAQ身体限制）、感知总体健康状况和总体生活质量的总体影响。我们在同一年内评估了这些关联，并评估了心绞痛与1年后报告的生活质量之间的时间滞后关联。使用广义估计方程模型来处理重复测量以及受试者内反应的相关性。在5年的随访中，有每日或每周心绞痛症状的患者在调整后生活质量得分较低（52对89，p<0.001），身体限制更大（61对86，p<0.001）。与有每日或每周心绞痛症状的患者相比，无心绞痛症状的患者生活质量更好的几率高2倍（优势比2.39，95%置信区间1.76至3.25），感知总体健康状况更好的几率高5倍（优势比5.45，95%置信区间3.85至7.73）。总之，心绞痛发作频率与CAD患者的生活质量和身体功能密切相关。即使在对临床风险因素和受试者内重复测量进行建模调整后，我们发现心绞痛症状发作频率较低与更好的生活质量相关。
