Prognosis of angina with and without a diagnosis: 11 year follow up in the Whitehall II prospective cohort study
Prognosis of angina with and without a diagnosis: 11 year follow up in the Whitehall II prospective cohort study
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DOI：
10.1136/bmj.327.7420.895
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发表时间：
2003-10-18
影响因子：
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通讯作者：
Marmot, M
中科院分区：
文献类型：
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作者：
Hemingway, H;Shipley, M;Marmot, M
目的探讨心绞痛患者的预后，包括心绞痛的诊断和心血管检查结果异常者。设计前瞻性队列研究，中位随访时间为11年。研究对象为最初位于伦敦的20个公务员部门。参与者为10308名公务员，基线年龄为35-55岁。主要结果指标：心绞痛的复发报告;生活质量（SF-36身体功能）;非致命性心肌梗死;任何原因死亡（n = 344）。结果1158例（11.4%）参与者发生心绞痛，813例（70%）在最初报告时没有医生诊断的证据。与随访期间既无心绞痛也无心肌梗死的受试者相比，未确诊的受试者身体功能受损的风险增加（年龄和性别调整的比值比为2.36（95%置信区间为1.91至2.90））。在报告的无诊断心绞痛病例中，15.5%的研究心电图异常患者死亡风险增加（风险比2.37（1.16 - 4.87））。这些影响的幅度与参与者诊断angina.Conclusion未确诊的心绞痛是常见的，并有不良影响的预后可比的诊断心绞痛，特别是在人与心电图异常。改善心绞痛患者预后的努力应该考虑到这座淹没的临床冰山。
Objective To investigate the prognosis of angina among people with and without diagnosis by a doctor and an abnormal cardiovascular test result.Design Prospective cohort study with a median follow up of 11 years.Setting 20 civil service departments originally located in London.Participants 10 308 civil servants aged 35-55 years at baseline.Main outcome measures Recurrent reports of angina; quality of life (SF-36 physical functioning); non-fatal myocardial infarction; death from any cause (n = 344).Results 1158 (11.4%) participants developed angina, and 813 (70%) had no evidence of diagnosis by a doctor at the time of the initial report. Participants without a diagnosis had an increased risk of impaired physical functioning (age and sex adjusted odds ratio of 2.36 (95% confidence interval 1.91 to 2.90)) compared with those who had neither angina nor myocardial infarction throughout follow up. Among reported cases of angina without a diagnosis, the 15.5% with an abnormality on a study electrocardiogram had an increased risk of death (hazard ratio 2.37 (1.16 to 4.87)). These effects were similar in magnitude to those in participants with a diagnosis of angina.Conclusion Undiagnosed angina was common and had an adverse impact on prognosis comparable to that of diagnosed angina, particularly among people with electrocardiographic abnormalities. Efforts to improve prognosis among people with angina should take account of this submerged clinical iceberg.