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

Health Services Research and Development Program, Seattle Veterans Affairs Medical Center, Washington.

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.

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				J. A. Spertus, R. Nerella, R. Kettlekamp, J. House, S. Marso, A. M. Borkon, and J. S. Rumsfeld Risk of Restenosis and Health Status Outcomes for Patients Undergoing Percutaneous Coronary Intervention Versus Coronary Artery Bypass Graft Surgery Circulation, February 15, 2005; 111(6): 768 - 773. [Abstract] [Full Text] [PDF]

				J. Kim, R. A. Henderson, S. J. Pocock, T. Clayton, M. J. Sculpher, K. A.A. Fox, and RITA-3 Trial Investigators Health-related quality of life after interventional or conservative strategy in patients with unstable angina or non-ST-segment elevation myocardial infarction: One-year results of the third randomized intervention trial of unstable angina (RITA-3) J. Am. Coll. Cardiol., January 18, 2005; 45(2): 221 - 228. [Abstract] [Full Text] [PDF]

				J. A. Spertus, A. C. Salisbury, P. G. Jones, D. G. Conaway, and R. C. Thompson Predictors of Quality-of-Life Benefit After Percutaneous Coronary Intervention Circulation, December 21, 2004; 110(25): 3789 - 3794. [Abstract] [Full Text] [PDF]

				P. Moons Why Call it Health-Related Quality of Life When You Mean Perceived Health Status? European Journal of Cardiovascular Nursing, December 1, 2004; 3(4): 275 - 277. [Abstract] [Full Text] [PDF]

				S Schroter and D L Lamping Coronary revascularisation outcome questionnaire (CROQ): development and validation of a new, patient based measure of outcome in coronary bypass surgery and angioplasty Heart, December 1, 2004; 90(12): 1460 - 1466. [Abstract] [Full Text] [PDF]

				M. C. Odden, M. A. Whooley, and M. G. Shlipak Association of Chronic Kidney Disease and Anemia with Physical Capacity: The Heart and Soul Study J. Am. Soc. Nephrol., November 1, 2004; 15(11): 2908 - 2915. [Abstract] [Full Text] [PDF]

				R. Kettelkamp, J. House, M. Garg, R. S. Stuart, A. Grantham, and J. Spertus Using the Risk of Restenosis as a Guide to Triaging Patients Between Surgical and Percutaneous Coronary Revascularization Circulation, September 14, 2004; 110(11_suppl_1): II-50 - II-54. [Abstract] [Full Text] [PDF]

				J. A. P. van der Sloot, M. Huikeshoven, R. Tukkie, H. J. Verberne, J. van der Meulen, B. L. F. van Eck-Smit, M. J. C. van Gemert, J. G. P. Tijssen, and J. F. Beek Transmyocardial revascularization using an XeCl excimer laser: Results of a randomized trial Ann. Thorac. Surg., September 1, 2004; 78(3): 875 - 881. [Abstract] [Full Text] [PDF]

				R. Ascione, B. C. Reeves, F. C. Taylor, H. K. Seehra, and G. D. Angelini Beating heart against cardioplegic arrest studies (BHACAS 1 and 2): quality of life at mid-term follow-up in two randomised controlled trials Eur. Heart J., May 1, 2004; 25(9): 765 - 770. [Abstract] [Full Text] [PDF]

				G. Johnston, J. R. Goss, J. A. Malmgren, and J. A. Spertus Health status and social risk correlates of extended length of stay following coronary artery bypass surgery Ann. Thorac. Surg., February 1, 2004; 77(2): 557 - 562. [Abstract] [Full Text] [PDF]

				J. F. Beek, J. A. P. van der Sloot, M. Huikeshoven, H. J. Verberne, B. L. F. van Eck-Smit, J. van der Meulen, J. G. P. Tijssen, M. J. C. van Gemert, and R. Tukkie Cardiac denervation after clinical transmyocardial laser revascularization: Short-term and long-term iodine 123-labeled meta-iodobenzylguanide scintigraphic evidence J. Thorac. Cardiovasc. Surg., February 1, 2004; 127(2): 517 - 524. [Abstract] [Full Text] [PDF]

				C. Pizzi, O. Manfrini, F. Fontana, and R. Bugiardini Angiotensin-Converting Enzyme Inhibitors and 3-Hydroxy-3-Methylglutaryl Coenzyme A Reductase in Cardiac Syndrome X: Role of Superoxide Dismutase Activity Circulation, January 6, 2004; 109(1): 53 - 58. [Abstract] [Full Text] [PDF]

				B. Ruo and M. Whooley Depression and Health-Related Quality of Life--Reply JAMA, November 12, 2003; 290(18): 2404 - 2404. [Full Text] [PDF]

				Z. Zhang, E. M. Mahoney, R. H. Stables, J. Booth, F. Nugara, J. A. Spertus, and W. S. Weintraub Disease-Specific Health Status After Stent-Assisted Percutaneous Coronary Intervention and Coronary Artery Bypass Surgery: One-Year Results From the Stent or Surgery Trial Circulation, October 7, 2003; 108(14): 1694 - 1700. [Abstract] [Full Text] [PDF]

				B. Ruo, J. S. Rumsfeld, M. A. Hlatky, H. Liu, W. S. Browner, and M. A. Whooley Depressive Symptoms and Health-Related Quality of Life: The Heart and Soul Study JAMA, July 9, 2003; 290(2): 215 - 221. [Abstract] [Full Text] [PDF]

				K. Harkness, L. Morrow, K. Smith, M. Kiczula, and H. M. Arthur The Effect of Early Education on Patient Anxiety While Waiting for Elective Cardiac Catheterization European Journal of Cardiovascular Nursing, July 1, 2003; 2(2): 113 - 121. [Abstract] [Full Text] [PDF]

				K. J. Guleserian, H. S. Maniar, C. J. Camillo, M. S. Bailey, R. J. Damiano Jr, and M. R. Moon Quality of life and survival after transmyocardial laser revascularization with the holmium:YAG laser Ann. Thorac. Surg., June 1, 2003; 75(6): 1842 - 1848. [Abstract] [Full Text] [PDF]

				S. Fuchs, L. F. Satler, R. Kornowski, P. Okubagzi, G. Weisz, R. Baffour, R. Waksman, N. J. Weissman, M. Cerqueira, M. B. Leon, et al. Catheter-based autologous bone marrow myocardial injection in no-option patients with advanced coronary artery disease: A feasibility study J. Am. Coll. Cardiol., May 21, 2003; 41(10): 1721 - 1724. [Abstract] [Full Text] [PDF]

				J. A. Spertus, M. J. Radford, N. R. Every, E. F. Ellerbeck, E. D. Peterson, and H. M. Krumholz Challenges and opportunities in quantifying the quality of care for acute myocardial infarction: Summary from the acute myocardial infarction working group of the American heart association/American college of cardiology first scientific forum on quality of care and outcomes research in cardiovascular disease and stroke J. Am. Coll. Cardiol., May 7, 2003; 41(9): 1653 - 1663. [Full Text] [PDF]