title: 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.
  
  
  OBJECTIVE
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Faculty of Health Sciences, McMaster University, F.H.Sc. 2J29, 1200 Main Street West, Hamilton, Canada, ON L8N 3Z5. arthurh@mcmaster.ca
authors.forename: H M
authors.initials: HM
authors.lastname: Arthur
authors.forename: K M
authors.initials: KM
authors.lastname: Smith
authors.forename: M K
authors.initials: MK
authors.lastname: Natarajan
mesh_terms: D000368:Aged; D001007:Anxiety / Q000523:psychology; D017023:Coronary Angiography / Q000379:methods / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011788:Quality of Life / Q000523:psychology*; D012017:Referral and Consultation; D011795:Surveys and Questionnaires; D016896:Treatment Outcome