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Predicting death from coronary heart disease using a questionnaire.

C J Bulpitt1, M J Shipley, J Demirovic

  • 1London School of Hygiene and Tropical Medicine, UK.

International Journal of Epidemiology
|December 1, 1990
PubMed
Summary

A questionnaire screening tool effectively predicts coronary heart disease (CHD) mortality in men. Combining 11 questions, including chest pain and dyspnea, offers the best balance of specificity and sensitivity for population studies.

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Area of Science:

  • Cardiovascular epidemiology
  • Public health screening

Background:

  • Coronary heart disease (CHD) remains a leading cause of mortality.
  • Effective screening tools are crucial for population health management.
  • The Whitehall study provides a valuable dataset for epidemiological research.

Purpose of the Study:

  • To evaluate the predictive power of a questionnaire for ten-year CHD mortality.
  • To assess the utility of self-reported symptoms as a screening tool for CHD risk.
  • To identify optimal combinations of questions for population-based screening.

Main Methods:

  • Analysis of questionnaire responses from 18,322 male civil servants (aged 40-64).
  • Examination of ten-year CHD mortality data (1714 deaths, 723 from CHD).
  • Evaluation of different algorithms based on reported symptoms (angina, chest pain, dyspnea, diabetes, physician visits).

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Main Results:

  • Angina plus possible myocardial infarction (PMI) yielded 99% specificity but only 7% sensitivity.
  • Angina and/or PMI improved sensitivity to 29% with 90% specificity.
  • An 11-question algorithm including dyspnea, diabetes, and physician visits achieved 85% specificity and 44% sensitivity.
  • Excluding 'yes-set' responders slightly increased specificity but reduced sensitivity.

Conclusions:

  • A multi-symptom questionnaire, particularly an 11-question combination, is recommended for CHD screening.
  • This screening approach balances high specificity with improved sensitivity for identifying at-risk individuals.
  • Further refinement of screening questions may enhance predictive accuracy for coronary heart disease mortality.