Abstract 17489: Large Variability of Patient Reported Angina Frequency within Provider Assigned Canadian Cardiovascular Society Angina Class

Abstract

Background: Whereas the Canadian Cardiovascular Society (CCS) classification grades angina severity from providers’ perspectives, the Seattle Angina Questionnaire (SAQ) Angina Frequency scale does so from patients’ perspectives. The concordance of angina severity from providers’ and patients’ perspectives has not been previously reported.

Methods: We compared CCS and SAQ Angina Frequency scores among 1,427 patients from 10 centers in the PRISM (Personalized Risk Information Services Manager) study who underwent elective PCI. The distribution of SAQ angina frequency score categories (daily (SAQ scores=0-30), weekly (31-60), monthly (61-99) and none (100)) within CCS class was determined. Physician variability in CCS assignment, based upon SAQ angina frequency, was assessed using proportional odds models with a random effect for PCI operator.

Results: CCS class 0, I, II, III and IV angina was present in 24%, 8%, 29%, 24% and 16% of patients, while angina frequency was reported by patients as none, daily, weekly and monthly in 27%, 32%, 32%, and 10%, respectively. The distribution of patient-reported angina frequency within each CCS class is shown in Figure 1. Although higher CCS classes were correlated with worse SAQ angina frequency scores (Spearmen coefficient -0.53, p < 0.001), there was marked heterogeneity within each CCS class. Notably, 35% of patients classified as having CCS IV angina reported no or only monthly angina. There was a >2-fold relative odds (Median Odds Ratio (MOR) = 2.07) that two randomly selected physicians would assign a patient with weekly angina different CCS classes. The MORs for patients with daily, monthly or no angina were 1.39, 1.80 and 2.33.

Conclusions: In this large cohort of contemporary PCI, marked heterogeneity in physician assignment of CCS class was observed, as compared with patients’ reports of their angina frequency. The implications of this variability on ratings of appropriateness deserve further study.