Seattle Angina Questionnaire Works Equally Well in Women

The Seattle Angina Questionnaire (SAQ), designed to assess the impact of ischemic heart disease on a patient’s symptoms, functions, and quality of life, works as well in women as it does in men, according to a new analysis.

The study, which included 8,892 men and 4,013 women, suggested comparable performance for the assessment of ischemic heart disease in both sexes, even though the SAQ was initially developed largely from a cohort of mostly male patients enrolled in US Department of Veterans Affairs hospitals.

“[The SAQ] can be confidently used as a tool to assess outcomes in clinical trials, to study the care and outcomes of women and men, and [to be] integrated into clinical care as an efficient mechanism for reproducibly assessing the health status of patients with ischemic heart disease,” lead investigator Krishna Patel, MD (Saint Luke’s Mid America Heart Institute, Kansas City, MO), told TCTMD.

Over the years, some researchers have raised concerns about the validity of SAQ patient-reported outcomes in women compared with men, particularly since there are differences in the presentation and outcomes of men and women with ischemic heart disease.

Patel added that some studies have shown worse outcomes for women compared with men, but “whether this is truly reflecting worse outcomes in women, or different performance of the SAQ in women,” could not be clarified until the psychometric properties of the questionnaire were documented in women. Such psychometric properties include the SAQ summary score, as well as scores reflecting physical limitations, angina stability, angina frequency, treatment satisfaction, and quality of life.

Published April 20, 2018, in the American Heart Journal, the new analysis included data from two multicenter, randomized clinical trials—MERLIN-TIMI 36 and TERISA—and five prospective registries. In total, there were 8,729 patients hospitalized with ACS, 2,736 who underwent PCI, and 917 who had stable angina.

Overall, the SAQ summary score showed “strong correlations” with Canadian Cardiovascular Society angina class in both men and women with stable ischemic heart disease. The physical limitations score was correlated with treadmill exercise duration and a general health survey score in men and women. The SAQ angina-frequency score was also strongly correlated with data taken from a daily angina diary in men and women, and the SAQ quality-of-life score in men and women was modestly correlated with other measures of health-related quality of life. In patients with ACS, the angina stability score was lower in both men and women when assessed 1 month after the event.     

“We believe that our findings should assure readers that the SAQ can validly, reliably, and sensitively capture the symptoms, function, and quality of life in all patients with coronary artery disease,” said Patel. The researchers point out that healthcare is moving towards rewarding value, quality, and patient-centered care, and that “patient-reported outcomes are becomingly increasingly important.”