Elsevier

American Heart Journal

Volume 201, July 2018, Pages 117-123
American Heart Journal

Clinical Investigation
Validation of the Seattle angina questionnaire in women with ischemic heart disease

https://doi.org/10.1016/j.ahj.2018.04.012Get rights and content

Abstract

Background

Although the Seattle Angina Questionnaire (SAQ) has been widely used to assess disease-specific health status in patients with ischemic heart disease, it was originally developed in a predominantly male population and its validity in women has been questioned.

Methods

Using data from 8892 men and 4013 women across 2 multicenter trials and 5 registries, we assessed the construct validity, test–retest reliability, responsiveness to clinical change, and predictive validity of the SAQ Summary Score (SS) and its 5 subdomains (Physical Limitation (PL), Anginal Stability (AS), Angina Frequency (AF), Treatment Satisfaction (TS), and Quality of Life (QoL)) separately in men and women.

Results

Comparable correlations of the SAQ SS with Canadian Cardiovascular Society class was demonstrated in both men and women (−0.48 for men, −0.46 for women). Similar correlations between the SAQ PL scale with treadmill exercise duration and Short Form-12 (SF-12) Physical Component Summary were observed in women and men (0.34–0.63 and 0.40–0.63, respectively). SAQ AS scores were significantly lower for both men and women with acute syndromes compared with 1 month later. The SAQ AF scale was strongly correlated with daily angina diaries (0.62 for men and 0.66 for women). The SAQ QoL scores were moderately correlated with the EQ5D visual analog scale and SF-12 general health question in men (0.43–0.50) and women (0.33–0.39). All SAQ scales demonstrated excellent reliability (intraclass correlation ≥0.78) in both men and women with stable CAD and were very sensitive to change after percutaneous coronary intervention (≥15-point difference in scores, standardized response mean ≥ 0.67). The SAQ SS was similarly predictive of 1-year mortality and cardiac re-hospitalizations for both men and women.

Conclusion

The SAQ demonstrates similar psychometric properties in men and women with CAD. These findings provide evidence for validity of the SAQ in assessing women with IHD.

Section snippets

Seattle Angina Questionnaire

The SAQ is a 19-item self-administered questionnaire measuring health status in patients with IHD across 5 domains: physical limitation (PL), angina stability (AS), angina frequency (AF), treatment satisfaction (TS), and quality of life (QoL).8 All domain scores and a summary score (SS; derived from the PL, AF, and QoL domains) range from 0 to 100, with higher scores indicating less angina, fewer physical limitations due to angina, and better QoL. The 7-item version excludes the TS and AS

Results

Our analytic cohort was derived from 2 multinational clinical trials (MERLIN-TIMI 36 and TERISA) and 5 prospective registries (PRESS, OPS, PRISM, PREMIER, and TRIUMPH; Table I). These studies included 8729 patients who were hospitalized with an acute coronary syndrome (5913 men and 2816 women), 2736 patients who underwent PCI (1964 men and 772 women) and 917 patients with stable angina (563 men and 354 women). Across all data sources, SAQ scores were available for 8440 men and 3952 women.

Discussion

Cardiovascular disease in women has historically received less attention,7., 22. despite the increased cost, morbidity, and mortality associated with it.11., 23., 24. As the health care landscape moves towards rewarding value, quality, and patient-centered care, patient-reported outcomes are becoming increasingly important. Instruments, such as the SAQ, that assess the impact of ischemic heart disease on patient's symptoms, function, and quality of life are ideally suited to become performance

Author Contributions

Drs. Patel and Spertus had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Study concept and design: Patel, Arnold, Jones, Spertus.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of initial manuscript: Patel.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Patel, Tang, Guo, Jones.

Administrative, technical, or material support:

Sources of Funding

The Prospective Registry Evaluating Outcomes After Myocardial Infarction: Events and Recovery (PREMIER) study was funded by CV Therapeutics, Palo Alto, California. The Translational Research Investigating Underlying Disparities in Acute Myocardial Infarction Patients' Health Status (TRIUMPH) study was funded by grant P50 HL 077113 from the National Heart, Lung and Blood Institute. This study was also funded in part by CV Outcomes, Inc., Kansas City, Missouri. The MERLIN-TIMI 36 Trial was funded

Disclosures

Dr. Spertus owns copyright for the Seattle Angina Questionnaire. He serves as a consultant to United Healthcare, Bayer and Novartis (modest). He has research grants from Abbott Vascular, Novartis and is the PI of an analytic center for the American College of Cardiology (significant). He has an equity interest in Health Outcomes Sciences (significant).

Dr. Morrow has research grants from Abbott Laboratories, Amgen, AstraZeneca, Daiichi Sankyo, Eisai, GlaxoSmithKline, Merck, Novartis, Roche

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