Chen A Y, Daley J, Thibault G E
Department of Medicine, Brockton/West Roxbury Veterans Affairs Medical, Center, Harvard Medical School, USA.
Med Decis Making. 1996 Apr-Jun;16(2):169-77. doi: 10.1177/0272989X9601600209.
To investigate the relationship between chronic stable angina patients' ratings of two health states (current health and health free of angina), the difference between these two ratings (the "anticipated gain"), and measures of anginal severity and comorbidity.
Cross-sectional interviews and questionnaires.
Out-patient clinics and medical inpatient service of a Veterans Affairs Medical Center.
Patients with chronic stable angina with no prior history of a revascularization procedure attending clinic appointments (n = 44) or electively admitted for cardiac catheterization (n = 11). Measurements. Ratings of current health and health free of angina using a verbal rating scale in which 0 = death and 100 = perfect health, the MOS SF-36, the Index of Coexistent Disease (a validated measure of comorbidity), and a question on the severity of anginal symptoms.
Mean (95% CI) rating of current health was 61.8 (59.2, 64.4) and that of health free of angina was 77.0 (74.5, 79.5). Median anticipated gain between the two health ratings was 10.0 (range 0-80). Correlations between ratings for both health states and subscales of the SF-36 were positive, with some reaching statistical significance. In regression models with rating of current health, rating of life without angina, and anticipated gain as the dependent variables, severity of comorbidity was highly significant in all three, whereas severity of angina was significant only in the current-health rating model. Severity of comorbidity had much greater explanatory power in all three models than did severity of angina.
Severity of comorbidity was a better predictor of patients' current health rating, rating for angina-free health, and anticipated gain from relief of angina than was severity of angina. Since patient perceptions of a symptom may be distinct from self-reported symptom severity, treatment-outcome studies should assess patient preferences in addition to symptom severity. Comorbidity should also be measured in such studies. Having patients rate current health and symptom-free health may be a useful measure of treatment effectiveness for specific symptoms in clinical trials and patient care, and may help patients and clinicians prioritize multiple health problems.
研究慢性稳定型心绞痛患者对两种健康状态（当前健康状态和无心绞痛的健康状态）的评分、这两种评分之间的差异（“预期获益”）以及心绞痛严重程度和合并症的测量指标之间的关系。
横断面访谈和问卷调查。
一家退伍军人事务医疗中心的门诊诊所和内科住院部。
无血管重建手术史的慢性稳定型心绞痛患者，其中44例前来门诊就诊，11例因心脏导管插入术而择期入院。测量方法：使用言语评定量表对当前健康状态和无心绞痛的健康状态进行评分，量表中0代表死亡，100代表完美健康；使用MOS SF-36量表；使用共存疾病指数（一种经过验证的合并症测量指标）；以及一个关于心绞痛症状严重程度的问题。
当前健康状态的平均（95%可信区间）评分为61.8（59.2，64.4），无心绞痛的健康状态评分为77.0（74.5，79.5）。两种健康评分之间的预期获益中位数为10.0（范围0 - 80）。两种健康状态的评分与SF-36量表各分量表之间的相关性均为正，部分具有统计学意义。在以当前健康状态评分、无心绞痛生活评分和预期获益为因变量的回归模型中，合并症严重程度在这三个模型中均具有高度显著性，而心绞痛严重程度仅在当前健康状态评分模型中具有显著性。在所有三个模型中，合并症严重程度的解释力均远大于心绞痛严重程度。
与心绞痛严重程度相比，合并症严重程度是患者当前健康状态评分、无心绞痛健康状态评分以及心绞痛缓解预期获益的更好预测指标。由于患者对症状的感知可能与自我报告的症状严重程度不同，治疗结果研究除了评估症状严重程度外，还应评估患者偏好。此类研究中还应测量合并症。让患者对当前健康状态和无症状健康状态进行评分，可能是临床试验和患者护理中特定症状治疗效果的有用测量指标，并且可能有助于患者和临床医生对多个健康问题进行优先排序。
