Clinical and Echocardiographic Correlates of Health Status in Patients with Acute Chest Pain
OBJECTIVE: To assess the ability of echocardiographic data to predict important functional status outcomes in patients with chest pain. DESIGN: Prospective cohort study. SETTING: A large, urban teaching hospital. PATIENTS: Three hundred thirty‐three patients admitted from the Emergency Department fo...
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| Veröffentlicht in: | Journal of general internal medicine : JGIM 1997-12, Vol.12 (12), p.751-756 |
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| creator | Fleischmann, Kirsten E. Lee, Richard T. Come, Patricia C. Goldman, Lee Kuntz, Karen M. Johnson, Paula A. Weissman, Matthew A. Lee, Thomas H. Sm |
| description | OBJECTIVE:
To assess the ability of echocardiographic data to predict important functional status outcomes in patients with chest pain.
DESIGN:
Prospective cohort study.
SETTING:
A large, urban teaching hospital.
PATIENTS:
Three hundred thirty‐three patients admitted from the Emergency Department for evaluation of chest pain.
MEASUREMENTS AND MAIN RESULTS:
Patients underwent two‐dimensional and Doppler echocardiography as well as a face‐to‐face interview during their initial hospitalization and a telephone interview 1 year thereafter. The interview included the Medical Outcomes Study 36‐Item Short Form (SF‐36) health inventory, a generic health status instrument with a physical function subscale. The relation between clinical and echocardiographic factors and functional status was explored by univariable and multivariable linear regression and logistic regression analyses. Multiple clinical and echocardiographic factors correlated significantly with functional status measures at 1 year. For the SF‐36 score at 1 year, age, male gender, white race, the presence of rales, and a comorbidity score were independently predictors in multivariate analysis; echocardiographic findings of severe left ventricular dysfunction (parameter estimate [PE] −27.6; 95% confidence interval [CI] −43.1, −12.2) and aortic insufficiency (PE −16.7; 95% CI −26.4, −7.0) added independent predictive information. Explanatory power (r 2) for models using clinical and demographic variables was .27 and increased after inclusion of echocardiographic data to an r 2 of .35. Results in the subset of patients (n= 148) with acute coronary syndromes such as unstable angina or myocardial infarction were qualitatively similar. Selected factors (rales on examination, electrocardiographic changes suggestive of ischemia, and moderate to severe mitral regurgitation) also predicted which patients would die or have a decline in their functional status. In multivariate analysis, only rales remained an independent predictor of poor outcome (odds ratio 2.4; 95% CI 1.2, 4.5).
CONCLUSIONS:
Echocardiographic data are correlated with measures of functional status in patients with chest pain, but the ability to predict future functional status from clinical or echocardiographic information is limited. Because functional status cannot be predicted adequately from either patients’ characteristics or echocardiographic testing, it must be assessed directly.
KEY WORDS:
chest pain; echocardiography; functional status |
| doi_str_mv | 10.1046/j.1525-1497.1997.07160.x |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_1497201</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>79520785</sourcerecordid><originalsourceid>FETCH-LOGICAL-c5250-851346e5b341bf5913a661c9e5b5f851a3a03e33743070b883b494ae529c62783</originalsourceid><addsrcrecordid>eNqNUU1v1DAQtRCoLAs_AclCqLcsdmzHzgGkKir9UCWQgBuSNfE6jVfeeLET2v57nO5qVThx8Vjz3sy8mYcQpmRFCa8-bFZUlKKgvJYrWueHSFqR1f0ztDgCz9GCKMULJRl_iV6ltCGEsrJUJ-ik5qxSNV-gn413gzPgMQxrfG76YCCuXbiNsOudwU2I0XoYbcKhw5cW_NjjbyOMU8JuwF9hdHYYE75zOX9mptHiprdpzIgbXqMXHfhk3xziEv34fP69uSxuvlxcNWc3hclaSaEEZbyyomWctp2oKYOqoqbOGdFlEBgQZhmTnBFJWqVYy2sOVpS1qUqp2BJ92vfdTe3Wrk1WFMHrXXRbiA86gNN_I4Pr9W34reczlfkoS3R6aBDDrynL11uXjPUeBhumpGUtSiKVyMR3_xA3YYpDXk4rWTFCK8kySe1JJoaUou2OSijRs316o2eXHsfr2T79aJ--z6Vvn25yLDz4lfH3BxxSNq2LMBiXjrQydxdkpn3c0-6ctw__PV5fX1zNP_YHLhu06Q</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>876301673</pqid></control><display><type>article</type><title>Clinical and Echocardiographic Correlates of Health Status in Patients with Acute Chest Pain</title><source>MEDLINE</source><source>EZB-FREE-00999 freely available EZB journals</source><source>Wiley Online Library All Journals</source><source>PubMed Central</source><source>Alma/SFX Local Collection</source><source>SpringerLink Journals - AutoHoldings</source><creator>Fleischmann, Kirsten E. ; Lee, Richard T. ; Come, Patricia C. ; Goldman, Lee ; Kuntz, Karen M. ; Johnson, Paula A. ; Weissman, Matthew A. ; Lee, Thomas H. ; Sm</creator><creatorcontrib>Fleischmann, Kirsten E. ; Lee, Richard T. ; Come, Patricia C. ; Goldman, Lee ; Kuntz, Karen M. ; Johnson, Paula A. ; Weissman, Matthew A. ; Lee, Thomas H. ; Sm</creatorcontrib><description>OBJECTIVE:
To assess the ability of echocardiographic data to predict important functional status outcomes in patients with chest pain.
DESIGN:
Prospective cohort study.
SETTING:
A large, urban teaching hospital.
PATIENTS:
Three hundred thirty‐three patients admitted from the Emergency Department for evaluation of chest pain.
MEASUREMENTS AND MAIN RESULTS:
Patients underwent two‐dimensional and Doppler echocardiography as well as a face‐to‐face interview during their initial hospitalization and a telephone interview 1 year thereafter. The interview included the Medical Outcomes Study 36‐Item Short Form (SF‐36) health inventory, a generic health status instrument with a physical function subscale. The relation between clinical and echocardiographic factors and functional status was explored by univariable and multivariable linear regression and logistic regression analyses. Multiple clinical and echocardiographic factors correlated significantly with functional status measures at 1 year. For the SF‐36 score at 1 year, age, male gender, white race, the presence of rales, and a comorbidity score were independently predictors in multivariate analysis; echocardiographic findings of severe left ventricular dysfunction (parameter estimate [PE] −27.6; 95% confidence interval [CI] −43.1, −12.2) and aortic insufficiency (PE −16.7; 95% CI −26.4, −7.0) added independent predictive information. Explanatory power (r 2) for models using clinical and demographic variables was .27 and increased after inclusion of echocardiographic data to an r 2 of .35. Results in the subset of patients (n= 148) with acute coronary syndromes such as unstable angina or myocardial infarction were qualitatively similar. Selected factors (rales on examination, electrocardiographic changes suggestive of ischemia, and moderate to severe mitral regurgitation) also predicted which patients would die or have a decline in their functional status. In multivariate analysis, only rales remained an independent predictor of poor outcome (odds ratio 2.4; 95% CI 1.2, 4.5).
CONCLUSIONS:
Echocardiographic data are correlated with measures of functional status in patients with chest pain, but the ability to predict future functional status from clinical or echocardiographic information is limited. Because functional status cannot be predicted adequately from either patients’ characteristics or echocardiographic testing, it must be assessed directly.
KEY WORDS:
chest pain; echocardiography; functional status; prognosis.</description><identifier>ISSN: 0884-8734</identifier><identifier>EISSN: 1525-1497</identifier><identifier>DOI: 10.1046/j.1525-1497.1997.07160.x</identifier><identifier>PMID: 9436894</identifier><language>eng</language><publisher>Cambridge, MA, USA: Blackwell Science, Inc</publisher><subject>Acute coronary syndromes ; adult learning theory ; Aged ; Angina pectoris ; Biological and medical sciences ; Cardiology. Vascular system ; Cardiopathies: etiologic forms (general aspects and miscellaneous) ; Coronary Disease - diagnosis ; Coronary Disease - diagnostic imaging ; curriculum ; Echocardiography, Doppler ; Emergency medical care ; evidence‐based medicine (EBM) ; Female ; Health Status ; Heart ; Heart attacks ; Hospitalization ; Humans ; Internal medicine ; Male ; medical education ; Medical prognosis ; Medical sciences ; Middle Aged ; Multivariate analysis ; Original ; Pain ; Patient satisfaction ; Predictive Value of Tests ; Prognosis ; Prospective Studies ; residents ; Treatment Outcome</subject><ispartof>Journal of general internal medicine : JGIM, 1997-12, Vol.12 (12), p.751-756</ispartof><rights>1997 by the Society of General Internal Medicine</rights><rights>1998 INIST-CNRS</rights><rights>Society of General Internal Medicine 1997</rights><rights>1997 by the Society of General Internal Medicine 1997</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c5250-851346e5b341bf5913a661c9e5b5f851a3a03e33743070b883b494ae529c62783</citedby><cites>FETCH-LOGICAL-c5250-851346e5b341bf5913a661c9e5b5f851a3a03e33743070b883b494ae529c62783</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC1497201/pdf/$$EPDF$$P50$$Gpubmedcentral$$H</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC1497201/$$EHTML$$P50$$Gpubmedcentral$$H</linktohtml><link.rule.ids>230,314,727,780,784,885,1416,27922,27923,45572,45573,53789,53791</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=2104504$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/9436894$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Fleischmann, Kirsten E.</creatorcontrib><creatorcontrib>Lee, Richard T.</creatorcontrib><creatorcontrib>Come, Patricia C.</creatorcontrib><creatorcontrib>Goldman, Lee</creatorcontrib><creatorcontrib>Kuntz, Karen M.</creatorcontrib><creatorcontrib>Johnson, Paula A.</creatorcontrib><creatorcontrib>Weissman, Matthew A.</creatorcontrib><creatorcontrib>Lee, Thomas H.</creatorcontrib><creatorcontrib>Sm</creatorcontrib><title>Clinical and Echocardiographic Correlates of Health Status in Patients with Acute Chest Pain</title><title>Journal of general internal medicine : JGIM</title><addtitle>J Gen Intern Med</addtitle><description>OBJECTIVE:
To assess the ability of echocardiographic data to predict important functional status outcomes in patients with chest pain.
DESIGN:
Prospective cohort study.
SETTING:
A large, urban teaching hospital.
PATIENTS:
Three hundred thirty‐three patients admitted from the Emergency Department for evaluation of chest pain.
MEASUREMENTS AND MAIN RESULTS:
Patients underwent two‐dimensional and Doppler echocardiography as well as a face‐to‐face interview during their initial hospitalization and a telephone interview 1 year thereafter. The interview included the Medical Outcomes Study 36‐Item Short Form (SF‐36) health inventory, a generic health status instrument with a physical function subscale. The relation between clinical and echocardiographic factors and functional status was explored by univariable and multivariable linear regression and logistic regression analyses. Multiple clinical and echocardiographic factors correlated significantly with functional status measures at 1 year. For the SF‐36 score at 1 year, age, male gender, white race, the presence of rales, and a comorbidity score were independently predictors in multivariate analysis; echocardiographic findings of severe left ventricular dysfunction (parameter estimate [PE] −27.6; 95% confidence interval [CI] −43.1, −12.2) and aortic insufficiency (PE −16.7; 95% CI −26.4, −7.0) added independent predictive information. Explanatory power (r 2) for models using clinical and demographic variables was .27 and increased after inclusion of echocardiographic data to an r 2 of .35. Results in the subset of patients (n= 148) with acute coronary syndromes such as unstable angina or myocardial infarction were qualitatively similar. Selected factors (rales on examination, electrocardiographic changes suggestive of ischemia, and moderate to severe mitral regurgitation) also predicted which patients would die or have a decline in their functional status. In multivariate analysis, only rales remained an independent predictor of poor outcome (odds ratio 2.4; 95% CI 1.2, 4.5).
CONCLUSIONS:
Echocardiographic data are correlated with measures of functional status in patients with chest pain, but the ability to predict future functional status from clinical or echocardiographic information is limited. Because functional status cannot be predicted adequately from either patients’ characteristics or echocardiographic testing, it must be assessed directly.
KEY WORDS:
chest pain; echocardiography; functional status; prognosis.</description><subject>Acute coronary syndromes</subject><subject>adult learning theory</subject><subject>Aged</subject><subject>Angina pectoris</subject><subject>Biological and medical sciences</subject><subject>Cardiology. Vascular system</subject><subject>Cardiopathies: etiologic forms (general aspects and miscellaneous)</subject><subject>Coronary Disease - diagnosis</subject><subject>Coronary Disease - diagnostic imaging</subject><subject>curriculum</subject><subject>Echocardiography, Doppler</subject><subject>Emergency medical care</subject><subject>evidence‐based medicine (EBM)</subject><subject>Female</subject><subject>Health Status</subject><subject>Heart</subject><subject>Heart attacks</subject><subject>Hospitalization</subject><subject>Humans</subject><subject>Internal medicine</subject><subject>Male</subject><subject>medical education</subject><subject>Medical prognosis</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Multivariate analysis</subject><subject>Original</subject><subject>Pain</subject><subject>Patient satisfaction</subject><subject>Predictive Value of Tests</subject><subject>Prognosis</subject><subject>Prospective Studies</subject><subject>residents</subject><subject>Treatment Outcome</subject><issn>0884-8734</issn><issn>1525-1497</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>1997</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNqNUU1v1DAQtRCoLAs_AclCqLcsdmzHzgGkKir9UCWQgBuSNfE6jVfeeLET2v57nO5qVThx8Vjz3sy8mYcQpmRFCa8-bFZUlKKgvJYrWueHSFqR1f0ztDgCz9GCKMULJRl_iV6ltCGEsrJUJ-ik5qxSNV-gn413gzPgMQxrfG76YCCuXbiNsOudwU2I0XoYbcKhw5cW_NjjbyOMU8JuwF9hdHYYE75zOX9mptHiprdpzIgbXqMXHfhk3xziEv34fP69uSxuvlxcNWc3hclaSaEEZbyyomWctp2oKYOqoqbOGdFlEBgQZhmTnBFJWqVYy2sOVpS1qUqp2BJ92vfdTe3Wrk1WFMHrXXRbiA86gNN_I4Pr9W34reczlfkoS3R6aBDDrynL11uXjPUeBhumpGUtSiKVyMR3_xA3YYpDXk4rWTFCK8kySe1JJoaUou2OSijRs316o2eXHsfr2T79aJ--z6Vvn25yLDz4lfH3BxxSNq2LMBiXjrQydxdkpn3c0-6ctw__PV5fX1zNP_YHLhu06Q</recordid><startdate>199712</startdate><enddate>199712</enddate><creator>Fleischmann, Kirsten E.</creator><creator>Lee, Richard T.</creator><creator>Come, Patricia C.</creator><creator>Goldman, Lee</creator><creator>Kuntz, Karen M.</creator><creator>Johnson, Paula A.</creator><creator>Weissman, Matthew A.</creator><creator>Lee, Thomas H.</creator><creator>Sm</creator><general>Blackwell Science, Inc</general><general>Springer</general><general>Springer Nature B.V</general><general>Blackwell Science Inc</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QL</scope><scope>7RV</scope><scope>7U9</scope><scope>7X7</scope><scope>7XB</scope><scope>88C</scope><scope>8AO</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>C1K</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>H94</scope><scope>K9.</scope><scope>M0S</scope><scope>M0T</scope><scope>M1P</scope><scope>M2O</scope><scope>M7N</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>RC3</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>199712</creationdate><title>Clinical and Echocardiographic Correlates of Health Status in Patients with Acute Chest Pain</title><author>Fleischmann, Kirsten E. ; Lee, Richard T. ; Come, Patricia C. ; Goldman, Lee ; Kuntz, Karen M. ; Johnson, Paula A. ; Weissman, Matthew A. ; Lee, Thomas H. ; Sm</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c5250-851346e5b341bf5913a661c9e5b5f851a3a03e33743070b883b494ae529c62783</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>1997</creationdate><topic>Acute coronary syndromes</topic><topic>adult learning theory</topic><topic>Aged</topic><topic>Angina pectoris</topic><topic>Biological and medical sciences</topic><topic>Cardiology. Vascular system</topic><topic>Cardiopathies: etiologic forms (general aspects and miscellaneous)</topic><topic>Coronary Disease - diagnosis</topic><topic>Coronary Disease - diagnostic imaging</topic><topic>curriculum</topic><topic>Echocardiography, Doppler</topic><topic>Emergency medical care</topic><topic>evidence‐based medicine (EBM)</topic><topic>Female</topic><topic>Health Status</topic><topic>Heart</topic><topic>Heart attacks</topic><topic>Hospitalization</topic><topic>Humans</topic><topic>Internal medicine</topic><topic>Male</topic><topic>medical education</topic><topic>Medical prognosis</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Multivariate analysis</topic><topic>Original</topic><topic>Pain</topic><topic>Patient satisfaction</topic><topic>Predictive Value of Tests</topic><topic>Prognosis</topic><topic>Prospective Studies</topic><topic>residents</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Fleischmann, Kirsten E.</creatorcontrib><creatorcontrib>Lee, Richard T.</creatorcontrib><creatorcontrib>Come, Patricia C.</creatorcontrib><creatorcontrib>Goldman, Lee</creatorcontrib><creatorcontrib>Kuntz, Karen M.</creatorcontrib><creatorcontrib>Johnson, Paula A.</creatorcontrib><creatorcontrib>Weissman, Matthew A.</creatorcontrib><creatorcontrib>Lee, Thomas H.</creatorcontrib><creatorcontrib>Sm</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Nursing & Allied Health Database</collection><collection>Virology and AIDS Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Healthcare Administration Database (Alumni)</collection><collection>ProQuest Pharma Collection</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>Environmental Sciences and Pollution Management</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Healthcare Administration Database</collection><collection>Medical Database</collection><collection>Research Library</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>Research Library (Corporate)</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest Central Basic</collection><collection>Genetics Abstracts</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Journal of general internal medicine : JGIM</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Fleischmann, Kirsten E.</au><au>Lee, Richard T.</au><au>Come, Patricia C.</au><au>Goldman, Lee</au><au>Kuntz, Karen M.</au><au>Johnson, Paula A.</au><au>Weissman, Matthew A.</au><au>Lee, Thomas H.</au><au>Sm</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Clinical and Echocardiographic Correlates of Health Status in Patients with Acute Chest Pain</atitle><jtitle>Journal of general internal medicine : JGIM</jtitle><addtitle>J Gen Intern Med</addtitle><date>1997-12</date><risdate>1997</risdate><volume>12</volume><issue>12</issue><spage>751</spage><epage>756</epage><pages>751-756</pages><issn>0884-8734</issn><eissn>1525-1497</eissn><abstract>OBJECTIVE:
To assess the ability of echocardiographic data to predict important functional status outcomes in patients with chest pain.
DESIGN:
Prospective cohort study.
SETTING:
A large, urban teaching hospital.
PATIENTS:
Three hundred thirty‐three patients admitted from the Emergency Department for evaluation of chest pain.
MEASUREMENTS AND MAIN RESULTS:
Patients underwent two‐dimensional and Doppler echocardiography as well as a face‐to‐face interview during their initial hospitalization and a telephone interview 1 year thereafter. The interview included the Medical Outcomes Study 36‐Item Short Form (SF‐36) health inventory, a generic health status instrument with a physical function subscale. The relation between clinical and echocardiographic factors and functional status was explored by univariable and multivariable linear regression and logistic regression analyses. Multiple clinical and echocardiographic factors correlated significantly with functional status measures at 1 year. For the SF‐36 score at 1 year, age, male gender, white race, the presence of rales, and a comorbidity score were independently predictors in multivariate analysis; echocardiographic findings of severe left ventricular dysfunction (parameter estimate [PE] −27.6; 95% confidence interval [CI] −43.1, −12.2) and aortic insufficiency (PE −16.7; 95% CI −26.4, −7.0) added independent predictive information. Explanatory power (r 2) for models using clinical and demographic variables was .27 and increased after inclusion of echocardiographic data to an r 2 of .35. Results in the subset of patients (n= 148) with acute coronary syndromes such as unstable angina or myocardial infarction were qualitatively similar. Selected factors (rales on examination, electrocardiographic changes suggestive of ischemia, and moderate to severe mitral regurgitation) also predicted which patients would die or have a decline in their functional status. In multivariate analysis, only rales remained an independent predictor of poor outcome (odds ratio 2.4; 95% CI 1.2, 4.5).
CONCLUSIONS:
Echocardiographic data are correlated with measures of functional status in patients with chest pain, but the ability to predict future functional status from clinical or echocardiographic information is limited. Because functional status cannot be predicted adequately from either patients’ characteristics or echocardiographic testing, it must be assessed directly.
KEY WORDS:
chest pain; echocardiography; functional status; prognosis.</abstract><cop>Cambridge, MA, USA</cop><pub>Blackwell Science, Inc</pub><pmid>9436894</pmid><doi>10.1046/j.1525-1497.1997.07160.x</doi><tpages>6</tpages><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0884-8734 |
| ispartof | Journal of general internal medicine : JGIM, 1997-12, Vol.12 (12), p.751-756 |
| issn | 0884-8734 1525-1497 |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_1497201 |
| source | MEDLINE; EZB-FREE-00999 freely available EZB journals; Wiley Online Library All Journals; PubMed Central; Alma/SFX Local Collection; SpringerLink Journals - AutoHoldings |
| subjects | Acute coronary syndromes adult learning theory Aged Angina pectoris Biological and medical sciences Cardiology. Vascular system Cardiopathies: etiologic forms (general aspects and miscellaneous) Coronary Disease - diagnosis Coronary Disease - diagnostic imaging curriculum Echocardiography, Doppler Emergency medical care evidence‐based medicine (EBM) Female Health Status Heart Heart attacks Hospitalization Humans Internal medicine Male medical education Medical prognosis Medical sciences Middle Aged Multivariate analysis Original Pain Patient satisfaction Predictive Value of Tests Prognosis Prospective Studies residents Treatment Outcome |
| title | Clinical and Echocardiographic Correlates of Health Status in Patients with Acute Chest Pain |
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