Patient-reported symptoms help predict heart disease death
People with chronic diseases, such as heart disease or diabetes, are often asked to answer questions about their health status, which might include information about their symptoms, physical limitations, and quality of life. Now, research published in Circulation: Journal of the American Heart Association suggests that this information may be helpful in predicting the risk of hospitalization and death in people with heart disease.
About the study
Researchers from the Mid America Heart Institute and Veterans Affairs (VA) Puget Sound Health Care System and colleagues analyzed data from the Ambulatory Care Quality Improvement Project—a study conducted in six VA medical centers between January 1997 and December 1999. Participants completed questionnaires about social and demographic information, medical history, and limitations due to health problems.
For this recent analysis of health status information as a predictor of hospitalization and mortality, only 5558 participants with coronary artery disease (CAD) were included. These participants also completed the Seattle Angina Questionnaire (SAQ), which is designed to assess:
- Physical limitations caused by angina (chest pain due to reduced blood flow to the heart)
- Frequency of angina
- Changes in angina symptoms
- Degree to which heart disease affects quality of life
The researchers checked the local VA medical systems and the national VA beneficiary identification system to identify participants who died during the study period. They also checked the admission and discharge records of the six VA centers that participated in the study to identify which patients were hospitalized for acute coronary syndrome (ACS).
Finally, the researchers compared the SAQ scores of participants who died or had been hospitalized with the SAQ scores of their counterparts who were still living.
Compared with participants who reported minimal physical limitations, those with moderate limitations were 2 times more likely to die within one year and those with severe limitations were 4 times more likely to die within the year. In addition, compared with participants who reported minimal frequency of angina, those with moderate and severe angina frequency were 2 or more time more likely to be hospitalized for ACS.
These and other SAQ scores were associated with higher mortality and hospitalization, even after considering the role of other predictors, such as age, congestive heart failure, diabetes, and previous coronary procedures.
Although these results are interesting, there are limitations to this study. First, 98% of participants were men and 85% were white, so more research is needed to determine whether these results apply to women and people of other ethnic and racial groups. Second, SAQ questionnaires for 19% of participants were incomplete. This missing data detract from the strength of the study findings. Third, participants completed the SAQ only once at the start of the study, so their scores do not reflect potential changes in health status over time. Fourth, hospitalization information was collected only from the participating VA medical centers, which means that participants admitted to other hospitals were not represented in this study.
How does this affect you?
The findings of this study suggest that information you give your doctor regarding your symptoms and health status may help him or her evaluate your risk of future medical outcomes, such as hospitalization and death. In this study, patient-rated symptoms and health status helped predict future coronary-related hospitalization and death among people with heart disease.
If you have a chronic disease, such as heart disease, your doctor may already ask you questions about your symptoms and general health status. However, this is the first study to measure whether such patient-rated information can be used to assess the risk of specific medical outcomes in the future.
Dr. John A. Spertus, lead author of this study, explains the significance of these findings this way: “I wouldn’t recommend [health status surveys] in lieu of other tests, but it is not practical to give [CAD] patients a nuclear stress test every month.” Health status surveys may be helpful tools to use on a regular basis to supplement the use of more expensive and invasive tests.
Spertus JA, et al. Health status predicts long-term outcome in outpatients with coronary disease. Circulation . June 17, 2002;106. Note: Published online. Print version to be published at a later date.
Rumsfeld JS. Health status and clinical practice: when will they meet? Circulation . June 17, 2002;106. Note: Published online. Print version to be published at a later date.
Last reviewed June 18, 2002
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