Interpretation of the Seattle Angina Questionnaire as an Outcome Measure in Clinical Trials and Clinical Care

JCS 2022 Guideline Focused Update on Diagnosis and Treatment in Patients With Stable Coronary Artery Disease

“…Assessment of patient-reported outcomes at baseline can guide optimal therapeutics to improve prognosis for patients with CAD and is prerequisite for shared decision making. Further, the SAQ correlates with the degree of effort necessary to induce angina symptoms, 30 and initial patientreported outcomes assessment also aids in ruling out near-acute coronary syndrome (ACS)/unstable angina or futile patients for downstream diagnostic and therapeutic strategies (e.g., those with high frailty). It should be noted that serial patient-reported outcomes assessment can also evaluate the effect of therapeutics chosen and requirement of non-invasive imaging tests or invasive coronary angiography during the follow-up period.…”

“…For example, when evaluating 2 patients with an otherwise similar estimated risk of experiencing clinical events, a patient with a SAQ physical limitation and angina frequency score <25 points is 4-fold more likely to die and twice as likely to be hospitalized for an ACS than a patient who has similar clinical characteristics and SAQ score >75 points. 30,33,35 Yet, implementation of patientreported outcomes in routine clinical care requires the development of methods to regularly collect, score, and present the scores within the clinical workflow. Web-based or mobile application software would ideally allow the patient to complete the SAQ in the waiting room or immediately before a clinical visit, and the responses could then be integrated with the electronic health record for immediate physician review.…”

Comprehensive Quality-of-Life Outcomes With Invasive Versus Conservative Management of Chronic Coronary Disease in ISCHEMIA

“…We compared the proportion of patients in each treatment group who improved their SAQ Summary score by >5, >10, >15, and >20 points, roughly corresponding to values representing from ¼ standard deviation (SD) of baseline score to 1.0 SD. 22 This analysis used baseline severity groups categorized as minimal or no burden (SAQ Summary score 81-100), moderate burden (61-80), and moderately severe to severe burden (<60).…”

Improving Symptoms and Quality of Life in Stable Coronary Artery Disease: An Evolving Paradigm

“…A change of ≈3 points in the SAQ SS requires only a 1-item shift in response of 1 or 2 of the 19 questions asked in the SAQ (eg, change in angina frequency from 1 to 2 times/week to <1 time/week without change in frequency of nitrate use or a change from moderate to slight limitation of enjoyment). 12 In general, a 5-point change in SS is associated with between 2 to 6 shifts in response on the 19-item SAQ and is considered clinically meaningful. 12 As such, the average benefit of 2.3 points in SS between the 2 arms is much smaller than the within-group improvement in scores in both the study arms.…”

“…12 In general, a 5-point change in SS is associated with between 2 to 6 shifts in response on the 19-item SAQ and is considered clinically meaningful. 12 As such, the average benefit of 2.3 points in SS between the 2 arms is much smaller than the within-group improvement in scores in both the study arms. Although the rate of prescription of β-blockers and calcium channel blockers were similar in both invasive and conservative groups throughout the trial, patients in the conservative arm were much more likely to have other anti-anginal medications added to their regimen starting in the first 1 to 3 months, whereas this rate remained constant with a slight decrease over time in the invasive strategy arm.…”