2005. Angina Predicts Mortality in Outpatients with CAD Irrespective of Demographics or Comorbidities
CL Bryson, Puget Sound HSR&D Center of Excellence, D Mozaffarian, Puget Sound HSR&D Center of Excellence, JA Spertus, Mid-America Heart Institute, Kansas City, MB McDonell, Puget Sound HSR&D Center of Excellence, SD Fihn, Puget Sound HSR&D Center of Excellence

Objectives: To investigate whether relationships of anginal symptoms with total mortality are influenced by patient demographic and clinical characteristics. Age, race, education, and clinical comorbidities have been associated with differences in anginal symptoms, treatment, and outcomes among outpatients with coronary artery disease (CAD), but there is little data on whether these characteristics affect relationships between anginal symptoms and mortality.

Methods: We prospectively examined the association between anginal symptoms, as assessed by the Seattle Angina Questionnaire, and total mortality among veterans with CAD enrolled in the Ambulatory Care Quality Improvement Project, a randomized trial involving 7 VA outpatient centers. Relative risks (RR) for death were estimated with Cox models. Potential effect modification was primarily assessed for age, race, education, diabetes, and smoking, and secondarily assessed for prevalent congestive heart failure (CHF), myocardial infarction (MI), and coronary revascularization.

Results: There were 8,908 subjects identified with CAD and 896 deaths over 2 years mean follow-up time. After adjustment for potential confounders, persons reporting greater physical limitation due to angina had higher mortality: 27% higher with mild limitation (RR=1.27, 95% CI=0.98-1.64), 61% higher with moderate limitation (RR=1.61, 95% CI=1.27-2.05), and 2.5-fold higher with the most limitation (RR=2.55, 95% CI=1.97-3.30), compared to little or no limitation (p for trend < 0.001). There was no evidence that these relationships were modified by age, race, education, smoking, or the presence or absence of diabetes, CHF, prior MI, or prior coronary revascularization.

Conclusions: Among outpatients with CAD, self-reported anginal symptoms strongly, independently, and incrementally predict total mortality irrespective of differences in age, race, education, or clinical comorbidities.

Impact: While comorbid conditions may increase the overall risk of death, they do not modify the robust relationship between self-reported anginal symptoms and death.