ANGINA PATIENTS RATINGS OF CURRENT HEALTH AND HEALTH WITHOUT ANGINA -ASSOCIATIONS WITH SEVERITY OF ANGINA AND COMORBIDITY

Objective. To investigate the relationship between chronic stable angi na patients' ratings of two health states (current health and health f ree of angina), the difference between these two ratings (the ''antici pated gain''), and measures of anginal severity and comorbidity. Desig n. Cross-sectional interviews and questionnaires. Setting. Out-patient clinics and medical inpatient service of a Veterans Affairs Medical C enter. Participants. Patients with chronic stable angina with no prior history of a revascularization procedure attending clinic appointment s (n = 44) or electively admitted for cardiac catheterization (n = 11) . Measurements. Ratings of current health and health free of angina us ing a verbal rating scale in which 0 = death and 100 = perfect health, the MOS SF-36, the Index of Coexistent Disease (a validated measure o f comorbidity), and a question on the severity of anginal symptoms. Re sults. Mean (95% Cl) rating of current health was 61.8 (59.2, 64.4) an d that of health free of angina was 77.0 (74.5, 79.5). Median anticipa ted gain between the two health ratings was 10.0 (range 0-80). Correla tions between ratings for both health states and subscales of the SF-3 6 were positive, with some reaching statistical significance. In regre ssion models with rating of current health, rating of life without ang ina, and anticipated gain as the dependent variables, severity of como rbidity was highly significant in all three, whereas severity of angin a was significant only in the current-health rating model. Severity of comorbidity had much greater explanatory power in all three models th an did severity of angina. Conclusions. Severity of comorbidity was a better predictor of patients' current health rating, rating for angina -free health, and anticipated gain from relief of angina than was seve rity of angina. Since patient perceptions of a symptom may be distinct from self-reported symptom severity, treatment-outcome studies should assess patient preferences in addition to symptom severity. Comorbidi ty should also be measured in such studies. Having patients rate curre nt health and symptom-free health may be a useful measure of treatment effectiveness for specific symptoms in clinical trials and patient ca re, and may help patients and clinicians prioritize multiple health pr oblems.