Development and evaluation of the Seattle Angina Questionnaire: a new functional status measure for coronary artery disease.

OBJECTIVES This study sought to establish the validity, reproducibility and responsiveness of the Seattle Angina Questionnaire, a 19-item self-administered questionnaire measuring five dimensions of coronary artery disease: physical limitation, anginal stability, anginal frequency, treatment satisfaction and disease perception. BACKGROUND Assessing the functional status of patients is becoming increasingly important in both clinical research and quality assurance programs. No current functional status measure quantifies all of the important domains affected by coronary artery disease. METHODS Cross-sectional or serial administration of the Seattle Angina Questionnaire was carried out in four groups of patients: 70 undergoing exercise treadmill testing, 58 undergoing coronary angioplasty, 160 with initially stable coronary artery disease and an additional 84 with coronary artery disease. Evidence of validity was sought by comparing the questionnaire's five scales with the duration of exercise treadmill tests, physician diagnoses, nitroglycerin refills and other validated instruments. Reproducibility and responsiveness were assessed by comparing serial responses over a 3-month interval. RESULTS All five scales correlated significantly with other measures of diagnosis and patient function (r = 0.31 to 0.70, p < or = 0.001). Questionnaire responses of patients with stable coronary artery disease did not change over 3 months. The questionnaire was sensitive to both dramatic clinical change, as seen after successful coronary angioplasty, and to more subtle clinical change, as seen among outpatients with initially stable coronary artery disease. CONCLUSIONS The Seattle Angina Questionnaire is a valid and reliable instrument that measures five clinically important dimensions of health in patients with coronary artery disease. It is sensitive to clinical change and should be a valuable measure of outcome in cardiovascular research.

[1]  J J Albers,et al.  Regression of coronary artery disease as a result of intensive lipid-lowering therapy in men with high levels of apolipoprotein B. , 1990, The New England journal of medicine.

[2]  M A Hlatky,et al.  Relation of clinical and angiographic factors to functional capacity as measured by the Duke Activity Status Index. , 1991, The American journal of cardiology.

[3]  P. Hartigan,et al.  A comparison of angioplasty with medical therapy in the treatment of single-vessel coronary artery disease. Veterans Affairs ACME Investigators. , 1992, The New England journal of medicine.

[4]  R A Deyo,et al.  Reproducibility and responsiveness of health status measures. Statistics and strategies for evaluation. , 1991, Controlled clinical trials.

[5]  L. Campeau.  Letter: Grading of angina pectoris. , 1976, Circulation.

[6]  C. Naylor,et al.  The Canadian Cardiovascular Society Grading Scale for Angina Pectoris: Is It Time for Refinements? , 1992, Annals of Internal Medicine.

[7]  E. Braunwald,et al.  Unstable angina. A classification. , 1989, Circulation.

[8]  E. Cook,et al.  Pitfalls in the serial assessment of cardiac functional status. How a reduction in "ordinary" activity may reduce the apparent degree of cardiac compromise and give a misleading impression of improvement. , 1982, Journal of chronic diseases.

[9]  Edward B. Perrin,et al.  The Medical Outcomes Study. An application of methods for monitoring the results of medical care , 1989 .

[10]  M. Weir,et al.  The Cardiac Arrhythmia Suppression Trial Investigators: Preliminary Report: Effect of Encainide and Flecainide on Mortality in a Randomized Trial of Arrhythmia Suppression After Myocardial Infarction. , 1990 .

[11]  G. Guyatt,et al.  Measurement of health status. Ascertaining the minimal clinically important difference. , 1989, Controlled clinical trials.

[12]  R. Rosati,et al.  Prognostic importance of anginal symptoms in angiographically defined coronary artery disease. , 1981, The American journal of cardiology.

[13]  S. Greenfield,et al.  The Medical Outcomes Study , 1989 .

[14]  G. Guyatt,et al.  Measuring change over time: assessing the usefulness of evaluative instruments. , 1987, Journal of chronic diseases.

[15]  S. Kaplan,et al.  Assessing the Effects of Physician-Patient Interactions on the Outcomes of Chronic Disease , 1989, Medical care.

[16]  P. Peduzzi,et al.  Effect of Medical vs Surgical Treatment on Symptoms in Stable Angina Pectoris: The Veterans Administration Cooperative Study of Surgery for Coronary Arterial Occlusive Disease , 1979, Circulation.

[17]  Stanley Azen,et al.  Coronary Angiographic Changes with Lovastatin Therapy: The Monitored Atherosclerosis Regression Study (MARS) , 1993, Annals of Internal Medicine.

[18]  A. Giles,et al.  Plasmapheresis therapy in rheumatoid arthritis. A controlled, double-blind, crossover trial. , 1983, The New England journal of medicine.

[19]  R. Deyo.  The quality of life, research, and care. , 1991, Annals of internal medicine.

[20]  E F Cook,et al.  Comparative Reproducibility and Validity of Systems for Assessing Cardiovascular Functional Class: Advantages of a New Specific Activity Scale , 1981, Circulation.

[21]  V. Froelicher,et al.  The reproducibility of hemodynamic, electrocardiographic, and gas exchange data during treadmill exercise in patients with stable angina pectoris. , 1984, Chest.

[22]  C. Wells,et al.  A new clinical taxonomy for rating change in functional activities of patients with angina pectoris. , 1977, American heart journal.

[23]  M A Hlatky,et al.  A brief self-administered questionnaire to determine functional capacity (the Duke Activity Status Index). , 1989, The American journal of cardiology.

[24]  E. Passamani,et al.  Survival following coronary artery bypass grafting in patients with severe angina pectoris (CASS). An observational study. , 1985, The Journal of thoracic and cardiovascular surgery.

[25]  M. Bodenheimer,et al.  Bypass surgery for chronic stable angina: predictors of survival benefit and strategy for patient selection. , 1991, Annals of internal medicine.

[26]  I. Wiklund,et al.  The relationship between exercise tolerance and quality of life in angina pectoris , 1991, Clinical cardiology.

[27]  T D Koepsell,et al.  A General Method of Compliance Assessment Using Centralized Pharmacy Records: Description and Validation , 1988, Medical care.

[28]  W. Rogers,et al.  Preliminary report: effect of encainide and flecainide on mortality in a randomized trial of arrhythmia suppression after myocardial infarction. , 1989, The New England journal of medicine.