Abstract 15: Patient-Reported versus Physician-Estimated Angina in Patients Undergoing Percutaneous Coronary Intervention
Background: The primary indication for coronary revascularization in patients with stable ischemic heart disease (SIHD) is relief of angina and improvement in quality of life. In current clinical practice, the Canadian Cardiovascular Society Classification (CCSC) system is used to quantify angina. However, the CCSC is a subjective estimate of angina burden from the perspective of the physician, rather than the patient. Although previous studies have demonstrated discordance between physician-estimated and patient-reported assessment of angina, whether this discordance exists in patients undergoing percutaneous coronary intervention (PCI) is unknown.
Methods: We prospectively collected the Seattle Angina Questionnaire Angina Frequency (SAQ AF) scores on 769 patients undergoing PCI for SIHD and 895 patients undergoing PCI for unstable angina (UA) between 2009-2011 across 10 U.S. hospitals, and compared the SAQ AF categories of daily (SAQ AF 0 – 30), weekly (SAQ AF 31 – 60), monthly (SAQ AF 61 – 99) and no angina (SAQ AF = 100) over the past 4 weeks with the CCSC as captured in the National Cardiovascular Data Registry (NCDR) for PCI (Table 1).
Results: In patients with SIHD, 267 (35.2%) of 769 patients reported a SAQ AF score of 100 (no angina). Of those with no self-reported angina, 33 (12.4%) and 20 (7.5%) were assessed by physicians as having moderate (CCSC II) or severe (CCSC III or IV) angina, while 197 (73.8%) were reported to have no angina (CCSC 0). In patients with UA, 110 (12.3%) of 895 patients reported a SAQ AF of 100, despite being categorized as having unstable angina.
Conclusions: These data suggest a discordance between patient-reported and physician-assessed angina burden among patients undergoing PCI and may impact ratings of procedural appropriateness in the NCDR. Collecting patient-reported outcome measures with the SAQ may be a useful clinical tool for selecting patients who are likely to experience quality of life benefit after coronary revascularization.
