ASSESSMENT OF ANGINA PECTORIS AFTER MYOCARDIAL INFARCTION: COMPARISON OF “ROSE QUESTIONNAIRE” WITH PHYSICIAN JUDGMENT IN THE BETA-BLOCKER HEART ATTACK TRIAL

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Abstract
The London School of Hygiene Cardiovascular Questionnaire (Rose Questionnaire) was compared with physician opinion in assessment of angina pectoris in the Beta-Blocker Heart Attack Trial, a long-term (June 1978–October 1981), multicenter study of 3,837 post-myocardial infarction patients, half of whom were treated with propranolol and half with placebo. At baseline, about three times as many patients were thought to have angina by the physician as were diagnosed by the Questionnaire (36.1% vs. 11.5%). Over the average 25-month follow-up period, angina was identified by the physician 50% more often than by the Questionnaire (60.3% vs. 38.6%). The results for each treatment group (propranoiol or placebo) were very similar to these overall results. Associations between diagnosis of angina and other patient characteristics were similar for the two measures at baseline. Although the physician diagnosis of angina identified more patients who suffered a subsequent fatal or nonfatal event than did the Questionnaire, it also diagnosed more angina patients who did not have an event. Thus, each of the measures of angina predicted total mortality and coronary heart disease mortality to similar extents (comparable relative risks), even after adjustment for covariates. Neither measure was significantly predictive of recurrent nonfatal myocardial infarction. One measure is not clearly superior to the other in this population. Other factors, such as cost and type of personnel available to conduct the study, may determine which measure is preferred.