MONITORING THE QUALITY-OF-LIFE IN PATIENTS WITH CORONARY-ARTERY DISEASE

Monitoring the outcomes of treatment and quantifying patients' functio nal status have assumed a prominent role in both clinical trials and q uality assurance programs. Because patients with coronary artery disea se (CAD) may have comorbid illnesses, and because generic health statu s questionnaires may not focus on symptoms and impairments unique to c oronary disease, a generic measure of health status may not be suffici ent to detect important changes in patients' CAD. The responsiveness t o clinical change of the Seattle Angina Questionnaire (SAQ), a disease -specific measure for CAD, was compared with that of the Short Form-36 , a generic measure of health status. Both questionnaires were seriall y administered, 3 months apart, to 45 patients undergoing coronary ang ioplasty and to 130 patients with stable CAD. Most scales of both ques tionnaires improved significantly after coronary angioplasty. The resp onsiveness statistics of the SAQ exceeded those of the Short Form-36. Among 130 patients with initially stable angina, 33 deteriorated, 79 r emained stable, and 18 improved over 3 months of observation. Mean SAQ scores changed significantly and appropriately in each of these group s. In contrast, none of the Short Form-36 scales detected these more s ubtle changes. Although useful in assessing overall function, a generi c health status measure, such as the Short Form-36, may not be respons ive enough to detect important clinical changes in patients' CAD. A di sease-specific instrument, such as the SAQ, can be an important and re levant outcome measure in clinical trials or quality assurance program s.