Related Experiment Videos
A self-administered questionnaire for detection of unrecognised coronary heart disease
J D Cameron1, G L Jennings, S Kay
1La Trobe University, Melbourne.
Insights
A questionnaire effectively identifies undiagnosed coronary heart disease (CHD) in health surveys. This screening method is cost-effective, detecting CHD in individuals without traditional risk factors, including younger women.
Area of Science:
- Cardiology
- Public Health
- Preventive Medicine
Background:
- Classical cardiovascular risk factors do not identify all coronary heart disease (CHD) cases.
- Many individuals at high statistical risk do not develop CHD.
- Unrecognized CHD poses a significant public health challenge.
Purpose of the Study:
- To evaluate a questionnaire's utility in identifying unrecognized coronary heart disease (CHD).
- To assess the cost-effectiveness of questionnaire-based CHD screening.
- To compare risk factor distribution in newly diagnosed CHD patients versus controls.
Main Methods:
- A self-administered questionnaire identified chest pain consistent with myocardial ischemia.
- Participants with suspicious responses underwent treadmill exercise ECG testing.
- Data collected from 4070 respondents over 18 months.
Main Results:
- Thirty-two subjects (13.9% of those tested) were diagnosed with significant CHD.
- Unrecognized CHD was more prevalent in women, particularly younger women.
- No difference in classical risk factor distribution was found between diagnosed patients and controls.
Conclusions:
- Self-administered questionnaires are a useful tool for detecting unrecognized coronary heart disease (CHD).
- This screening approach is relatively cost-effective.
- The findings highlight the need for broader screening strategies beyond traditional risk factors.
Abstract:
On an individual and a population basis, an increased incidence of coronary heart disease is associated with classical cardiovascular risk factors, but many cases occur in people not identified as at high risk. Conversely, many people at high statistical risk do not develop coronary disease. We used a questionnaire to identify unrecognised coronary heart disease in people attending large-scale health survey centres. Participants were required to report the presence and characteristics of any chest pain. Those returning responses consistent with myocardial ischaemia were offered treadmill exercise ECG tests. Over 18 months, 4070 questionnaires were returned. Of 475 respondents offered testing, 229 (198 male, 131 female) accepted. Thirty-two subjects (15 male, 17 female: a detection rate of 13.9 per cent of those assessed as likely on questionnaire, or 0.8 per cent of all respondents) had results consistent with significant coronary heart disease. Follow-up was available in 30 cases. There was no difference in classical risk-factor distribution (including multivariate risk percentiles: 42.4 (male) and 46.7 (female)) between those newly diagnosed with coronary heart disease and their community counterparts. More women than men were identified as suffering from unrecognised coronary heart disease, with a preponderance of younger women. Cost per case identified was A$1220. Screening by self-administered questionnaire is a useful and relatively cost-effective means of identifying unrecognised coronary heart disease.