Predicting coronary heart disease events in women: a longitudinal cohort study.
BACKGROUND
More than 240 000 women in the United States die of coronary heart disease annually. Identifying women's symptoms that predict a coronary heart disease event such as myocardial infarction (MI) could decrease mortality.


OBJECTIVE
For this longitudinal observational study, we recruited 1097 women, who were either clinician referred or self-referred to a cardiologist and undergoing initial evaluation by a cardiologist, to assess the utility of the prodromal symptoms (PS) section of the McSweeney Acute and Prodromal Myocardial Infarction Symptom Survey (MAPMISS) in predicting the occurrence of cardiac events in women.


RESULTS
Seventy-seven women experienced events (angioplasty, stent placement, coronary artery bypass, MI, death) during the 2-year follow up. The most common events were stents alone (38.9%) or in combination with angioplasty (18.2%). Ten women had MIs; 4 experienced cardiac death. Cox proportional hazards was used to model time to event. The prodromal score was significantly associated with risk of an event (hazard ratio, 1.10; 95% confidence interval, 1.06-1.13), as was the number of PSs endorsed by each woman per visit. After covariate adjustment, 5 symptoms were significantly associated with increased risk: discomfort in jaws/teeth, unusual fatigue, arm discomfort, shortness of breath, and general chest discomfort (hazard ratio, 3.97; 95% confidence interval, 2.32-6.78). Women reporting 1 or more of these symptoms were 4 times as likely to experience a cardiac event as women with none.


CONCLUSIONS
Both the MAPMISS PS scores and number of PS were significantly associated with cardiac events, independent of risk factors, suggesting that there are specific PSs that can be easily assessed using the MAPMISS. This instrument could be an important component of a predictive screen to assist clinicians in deciding the course of management for women.
Jean McSweeney, PhD, RN, FAHA, FAAN Professor and Associate Dean for Research, College of Nursing, University of Arkansas for Medical Sciences, Little Rock. Mario A. Cleves, PhD Professor, College of Medicine, University of Arkansas for Medical Sciences, Little Rock. Ellen P. Fischer, PhD Research Health Scientist, Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, and Associate Professor, Department of Psychiatry & Behavioral Science, University of Arkansas for Medical Sciences, Little Rock. Debra K. Moser, DNSc, RN, FAHA, FAAN Professor and Gill Endowed Chair, College of Nursing, University of Kentucky, Lexington. Jeanne Wei, MD, PhD Professor, College of Medicine, University of Arkansas for Medical Sciences, Little Rock. Christina Pettey, MNSc, FNP-BC, APRN Doctoral Candidate and Clinical Assistant Professor, College of Nursing, University of Arkansas Medical Sciences, Little Rock. Martha O. Rojo, PhD Research Assistant, College of Nursing, University of Arkansas for Medical Sciences, Little Rock. Narain Armbya, MS Statistician, College of Medicine, University of Arkansas for Medical Sciences, Little Rock.
Jean
J
McSweeney
Mario A
MA
Cleves
Ellen P
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Fischer
Debra K
DK
Moser
Jeanne
J
Wei
Christina
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Pettey
Martha O
MO
Rojo
Narain
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Armbya
D000328:Adult; D003327:Coronary Disease / Q000150:complications* / Q000175:diagnosis* / Q000401:mortality; D005260:Female; D006306:Health Surveys; D006801:Humans; D008137:Longitudinal Studies; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D009204:Myocardial Revascularization; D011237:Predictive Value of Tests; D062706:Prodromal Symptoms; D016016:Proportional Hazards Models; D012307:Risk Factors; D012737:Sex Factors; D012959:Socioeconomic Factors; D015607:Stents; D013997:Time Factors