Prognostic value of a treadmill exercise score in outpatients with suspected coronary artery disease

Article Abstract:

Multiple regression analysis is a sophisticated statistical tool that has been applied to the study of many disease risk factors. However, the results are often too complex for routine use in the treatment of patients. Conversely, dividing patients into high- and low-risk groups is often too simplistic and erroneously implies that all patients within a group are comparable. A scoring technique has been devised to permit the evaluation of heart patients using the treadmill exercise test. Previous research has shown that different physiological variables measured during the treadmill test may be combined for an accurate prognosis of patients admitted to a hospital for work-up. This same test has now been evaluated for use with outpatients who are suspected of having coronary artery disease. A total of 613 patients were evaluated using the test and followed-up for a period of at least four years. The test, which is scored on a scale from -25 for the highest risk of disease to +15 for the lowest, proved to be even more reliable for outpatients than it had been for hospitalized patients. The test scores accurately indicated those patients who died during the follow-up period. Patients with scores better than +5 had a 99 percent survival for the 4-year period. The scoring procedure is presented in the form of a nomogram. This graphical device permits the evaluation of risk without the detailed mathematical calculations that would be necessary using regression. Using only a straightedge, measurements for chest pain, electrocardiographic abnormalities, and duration of exercise are connected. The intersection of the straight line with the prognosis scale directly yields the desired result. (Consumer Summary produced by Reliance Medical Information, Inc.)

Reports, Treadmill exercise tests, Predictive value of tests, Predictive value of tests (Medical)

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Value of the history and physical in identifying patients at increased risk for coronary artery disease

Article Abstract:

An initial evaluation by a physician may identify patients with significant coronary artery disease. This type of evaluation involves taking the patient's medical history, a physical examination and a series of simple laboratory tests. Among 1,030 patients with symptoms of coronary artery disease who were referred by a physician for noninvasive testing, 168 underwent cardiac catheterization within 90 days of their initial referral. Of the patients who underwent catheterization, 45 patients were diagnosed with severe coronary artery disease, 109 with significant coronary artery disease and 12 with left coronary artery disease. A correct prediction was made for 90% of the patients diagnosed with significant coronary artery disease during their initial evaluation with a physician. A correct prediction was made during an initial evaluation for 62% of the patients without significant coronary artery disease.

Diagnosis, Medical history taking, Medical examination, Periodic health examinations

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Prognostic importance of social and economic resources among medically treated patients with angiographically documented coronary artery disease

Article Abstract:

Patients with coronary artery disease who are at the low end of the socio-economic scale may have a higher mortality than those who are relatively well-off. Questionnaires assessing psychosocial and economic status were given to 1,368 patients with coronary artery disease who received coronary angiography between 1974 and 1980. They were followed up six and 12 months after angiography and every year thereafter. The average follow-up was nine years. Those with low incomes were twice as likely to die within the first five years than those with high incomes. Unmarried patients without a close friend were three times as likely to die within the first five years than those who were married or had a close friend. These risk factors were independent of any other risk factors for death from coronary artery disease.

Health aspects, Social aspects, Cardiovascular diseases, Social indicators

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