Abstract 139: Angina Frequency, Quality of Life and Functional Status in Patients with Stable Ischemic Heart Disease: Data from the Heart and Soul Study

Abstract

Background: Angina is a common symptom among patients with ischemic heart disease (IHD), but its long-term effects on quality of life and functional limitation have not been quantified. We sought to evaluate the longitudinal association of angina frequency with quality of life and functional limitation in patients with IHD. Methods: We enrolled 1023 outpatients with stable IHD in a prospective cohort study between 2000 and 2002. Participants completed the Seattle Angina Questionnaire (SAQ) at baseline and annually for five years. The longitudinal associations of SAQ angina frequency with overall quality of life (fair or poor vs. excellent, very good, or good), SAQ quality of life score, SAQ physical limitation score, and New York Heart Association (NYHA) functional class (III or IV vs. I or II) were estimated using mixed effects regression models with adjustment for clinical risk factors. Results: At baseline, 633 participants (62%) reported no angina, 279 (27%) reported monthly angina, and 111 (11%) reported daily or weekly angina. At baseline, participants with daily or weekly angina were more likely than those without angina to report fair or poor overall quality of life (46% vs. 18%, P<.001) and NYHA class III or IV symptoms (58% vs. 13%, P<0.001). During five years of follow-up, participants with daily or weekly angina had worse mean SAQ Quality of Life scores (51.7 vs. 89.2, P<.001) and SAQ Physical Limitation scores (62.4 vs. 84.9, P<.001) than participants without angina. After adjusting for age, sex, race, smoking, hypertension, history of heart failure, physical inactivity, depressive symptoms, and medication use, daily or weekly angina remained associated with worse mean SAQ Quality of Life scores (54.7 vs. 88.7, P<.001) and Physical Limitation scores (66.8 vs. 85.0, P<.001). In adjusted analyses, participants with daily or weekly angina had higher odds of reporting fair or poor quality of life (OR 1.78, 95%CI 1.18, 2.69, P<.001) and higher odds of reporting NYHA class III or IV symptoms (OR 6.17, 95%CI 4.34, 8.77, P<.001) during the follow-up period. Conclusions: Angina frequency was associated with longitudinal measures of quality of life and functional limitations in outpatients with IHD.