Knott C, Hopman WM, Abdollah H, Brenner K, Link C, Sanfilippo A; Academy for Health Services Research and Health Policy. Meeting.
Abstr Acad Health Serv Res Health Policy Meet. 2000; 17: UNKNOWN.
Presented by: Wilma M. Hopman, B.A.H., M.A., Director, MacKenzie Health Services Research Group, Department of Community Health and Epidemiology, Queen's University, Kingston, Ontario, Canada K7L 3N6 Tel: (613) 533-2548, fax: (613) 533-6940, E-mail: hopmanw@post.queensu.ca
Research Objective: The less favourable prognosis for women with ischemic chest pain is known to be related to delayed presentation and less accurate clinical assessment. In particular, traditional treadmill electrocardiographic stress testing (EST) is known to be less sensitive and specific in women than it is in men. A prospective trial has been undertaken to refine the clinical assessment within this patient population. As part of the study protocol, patient characteristics and health-related quality of life (HRQOL) are assessed at the time of initial clinical testing and at 6, 12 and 24 months following the initial assessment.Study Design: Patients are referred by family physicians, specialists and emergency rooms, and are enrolled in the study if they have undiagnosed chest pain and at least two cardiac risk factors. They are clinically evaluated, complete a baseline history and physical assessment, and are administered the Medical Outcomes Study 36-item short form health survey (SF-36). These women are then randomly assigned to one of 3 diagnostic strategies (EST, exercise echocardiography, or dobutamine stress echocardiography) with provisions for additional investigations in the event of indeterminate preliminary diagnostic testing. Population studied: Women with undiagnosed chest pain and a minimum of 2 cardiac risk factors.Principal Findings: To date, 34 women have completed both an initial and a follow-up SF-36 assessment. Mean age of the sample is 53.9 years (standard deviation 10.14), 17.6% are current or past smokers, 58.8% have a history of hypertension, and 76.5% are post-menopausal. Five (14.7%) were positive for cardiac chest pain on their initial test, 24 (70.6%) were negative and 5 (14.7%) were indeterminate. Both of the imaging modalities more frequently yielded conclusive results (positive/negative) than did the EST. Chest pain had resolved in close to half of the women at the time of their follow-up evaluation. The sample scored significantly lower compared to the normative data for Canadian women on all 8 domains of the SF-36. However, the sample did display improvement over a 6-month period was noted in role physical (p = 0.08), role emotional (p = 0.09) and mental health (p = 0.04) domains of the SF-36. These improvements were significantly more pronounced in those women whose chest pain had resolved at 6 months. Women who had unresolved chest pain at 6 months were on average 10 years younger (p = 0.001) than those whose chest pain had resolved. Conclusions: HRQOL scores are significantly and adversely affected by the presence of undiagnosed chest pain as compared to the normative population. This persists in several SF-36 domains even after cardiac chest pain has been ruled out. Implications for Policy, Delivery and Practice: Given the less favourable prognosis of women with ischemic chest pain and the less accurate clinical assessment of these women, it is important to assess the burden of illness and the effectiveness of various diagnostic strategies, as well as to identify the characteristics of those with positive versus negative results on the diagnostic tests.Primary Funding Source: No primary source.
Publication Types:
Keywords:
- Angina Pectoris
- Canada
- Chest Pain
- Echocardiography
- Echocardiography, Stress
- Exercise Test
- Female
- Humans
- Life
- Longitudinal Studies
- Male
- Medical History Taking
- Quality of Life
- Research Design
- Risk Factors
- diagnosis
- ultrasonography
- hsrmtgs
Other ID:
UI: 102272717
From Meeting Abstracts