Quality of life at referral predicts outcome of elective coronary artery angiogram

Abstract

Background: Patients' anxiety and quality of life (HRQL) are affected by waiting for diagnostic tests such as coronary artery angiogram (CATH). It is unknown whether HRQL and psychological status at the time of referral are related to likelihood of coronary artery disease (CAD) as diagnosed by CATH.

Purpose: The purposes of this study were (1) to determine patients' anxiety and HRQL at the time of referral for elective CATH and (2) to assess the impact of baseline HRQL on likelihood of CAD.

Methods: This was a prospective observational study of 1009 patients referred for elective CATH. Questionnaires were mailed to patients within 2 weeks of referral. Packages contained a general HRQL measure (SF-36), a condition-specific HRQL measure (Seattle Angina Questionnaire) and the State-Trait Anxiety Inventory (STAI). Patients returned the baseline questionnaires in a postage-paid envelope.

Results: : Complete data were available for 90.6% of patients (n=914). At baseline, general HRQL was significantly lower than population norms for healthy individuals (p<0.0001), but significantly higher than population norms for patients living with angina (p<0.02). Also at baseline, patients' (n=971) mean state anxiety score on the STAI was 44.3 (SD=13.3), reflecting 'high anxiety'. Logistic regression analysis revealed 3 predictors of angiographically documented CAD: male sex (OR 5.76; CI 3.75-8.84), the SF-36 physical functioning subscale (OR 1.05; CI 1.01-1.07) and older age (OR 2.38; CI 1.48-3.82).

Conclusion: At the time of referral for elective CATH patients have high levels of anxiety and poor HRQL. It is possible that patient-rated physical HRQL at the time of referral adds to our ability to triage patients according to urgency ratings.