Assessment of quality of life in patients with chest pain and normal coronary arteriogram (syndrome X) using a specific questionnaire

Abstract

Background: Prognosis in patients with syndrome X (chest pain and normal coronary arteriograms) is good; however, persistent chest pain and functional disability are common in these patients. Accurate assessment of quality of life may be useful for patient management. Aim: The quality of life status in patients with syndrome X was assessed using a specific questionnaire. This questionnaire was developed and validated for the assessment of quality of life in patients with typical chest pain despite normal coronary arteriograms. Methods: Ninety consecutive patients were invited to complete both the questionnaire (on two occasions within 2 weeks) and a standardized angina diary. Fully completed questionnaires were received from 66 (73%) patients (mean age 58±8 years, 55 women). Results: Answers were scored according to a grading system where higher scores indicate worse quality of life. We observed that total scores increased with severity of angina (Canadian Class I, 38 ± 16, II: 93 ± 29, III-IV, 119 ± 23; p < 0.001) and correlated with both the number and the severity of chest pain episodes (r= 0.50-0.66: p < 0.001). In patients who remained clinically stable (n = 37) during the 2-week assessment, test-retest analysis showed no score differences (87 ± 30 vs. 81 ± 30; p = 0.1), while total score increased in patients (n = 24) whose symptoms worsened (108 ± 31 vs. 116 ± 31; p < 0.02) and was reduced in those (n = 5) whose symptoms improved (55 ± 37 vs. 39 ± 28; p < 0.04). Conclusion: Our study shows that quality of life is significantly impaired in patients with syndrome X and that the specific questionnaire used for assessment is a reliable and sensitive tool for the evaluation of quality of life in patients with chest pain and normal coronary arteriograms.