The Canadian Cardiovascular Society grading scale for angina pectoris: is it time for refinements?

Abstract:

OBJECTIVE:To appraise the measurement properties of the Canadian Cardiovascular Society (CCS) classification of stable angina pectoris. DATA SOURCES:Relevant articles were identified through a MEDLINE search (1976 to November 1991). Bibliographies of retrieved articles were also reviewed. STUDY SELECTION:Studies chosen directly addressed the validity and reliability of the CCS scale. Recent studies and reviews of related topics (for example, silent ischemia) are selectively cited. DATA SYNTHESIS:No data address the scale's applicability, that is, how clinicians typically assign angina grades in practice. Comprehensiveness would be improved by coverage of the patient's perceptions of symptom burden; mixed exertional and rest symptoms; episodic or changing symptoms; and modifying factors. Reliability was assessed in one study with two clinicians; the interobserver, chance-corrected agreement on patient grading was 60%. Content validity (the ability of the scale to measure what it claims) is threatened by the unproven assumption of symptomatic or physiologic equivalence among diverse levels of different activities within any given grade of angina. Construct validity is uncertain, given weak relations between angina grade and noninvasive markers of ischemia, anatomical disease, or prognosis. The scale's responsiveness (the ability to detect the smallest clinically important changes) is limited by the reliance on four coarse gradations based on only ambulation or stair-climbing. CONCLUSIONS:The CCS scale for stable angina might be made more useful by developing measurements for patients' self-rated symptom burden and the changes they deem important; by adding items on clinical instability (that is, progressive symptoms or pain at rest); and by empirically testing the current scale to eliminate redundant or inconsistent elements.

journal_name

Ann Intern Med

authors

Cox J,Naylor CD

doi

10.7326/0003-4819-117-8-677

subject

Has Abstract

pub_date

1992-10-15 00:00:00

pages

677-83

issue

8

eissn

0003-4819

issn

1539-3704

journal_volume

117

pub_type

杂志文章
  • Pemphigus: current concepts.

    abstract::Pemphigus is an autoimmune intraepidermal bullous disease involving the skin and mucous membranes. There are four clinically recognized variants of this disease. The histopathologic hallmark is acantholysis, which is disruption of normal cell-to-cell adhesion. Patients produce an IgG antibody directed against an antig...

    journal_title:Annals of internal medicine

    pub_type: 杂志文章,评审

    doi:10.7326/0003-4819-92-3-396

    authors:

    更新日期:1980-03-01 00:00:00

  • Screening for hereditary hemochromatosis in siblings and children of affected patients. A cost-effectiveness analysis.

    abstract:BACKGROUND:Screening for hereditary hemochromatosis is traditionally done by using serum iron studies. However, mutation analysis of the hemochromatosis-associated HFE gene has recently become available. OBJECTIVE:To compare the cost-effectiveness of no screening with four screening strategies that incorporate HFE gen...

    journal_title:Annals of internal medicine

    pub_type: 杂志文章

    doi:10.7326/0003-4819-132-4-200002150-00003

    authors: El-Serag HB,Inadomi JM,Kowdley KV

    更新日期:2000-02-15 00:00:00

  • Occupational exposures to body fluids among medical students. A seven-year longitudinal study.

    abstract:BACKGROUND:Medical students may be at high risk for occupational exposures to blood. OBJECTIVE:To measure the frequency of medical students' exposure to infectious body substances, to identify factors that affect the probability of such exposure, and to suggest targets for the prevention of such exposure. DESIGN:Revi...

    journal_title:Annals of internal medicine

    pub_type: 杂志文章

    doi:10.7326/0003-4819-130-1-199901050-00009

    authors: Osborn EH,Papadakis MA,Gerberding JL

    更新日期:1999-01-05 00:00:00

  • Genetic variation in the renin-angiotensin system and abdominal adiposity in men: the Olivetti Prospective Heart Study.

    abstract:BACKGROUND:The renin-angiotensin system is involved in adipocyte growth and differentiation and possibly in adipose tissue metabolism. OBJECTIVE:To investigate the association of polymorphism in the angiotensin-converting enzyme (ACE) I/D gene, angiotensinogen M235T gene, and angiotensin II type 1 receptor A1166C gene...

    journal_title:Annals of internal medicine

    pub_type: 杂志文章

    doi:10.7326/0003-4819-138-1-200301070-00007

    authors: Strazzullo P,Iacone R,Iacoviello L,Russo O,Barba G,Russo P,D'Orazio A,Barbato A,Cappuccio FP,Farinaro E,Siani A,Olivetti Prospective Heart Study.

    更新日期:2003-01-07 00:00:00

  • New federal initiatives to enhance the medical treatment of opioid dependence.

    abstract::Opioid dependence is a chronic relapsing medical condition with substantial health and societal complications. Recent federal initiatives are designed to enhance the medical treatment of patients with opioid dependence and will expand the role of internists in the care of these patients. These initiatives include a pr...

    journal_title:Annals of internal medicine

    pub_type: 杂志文章

    doi:10.7326/0003-4819-137-8-200210150-00014

    authors: Fiellin DA,O'Connor PG

    更新日期:2002-10-15 00:00:00

  • Changes in DNA methylation in neoplasia: pathophysiology and therapeutic implications.

    abstract::Methylation of DNA is a biochemical modification that can influence gene expression and is involved in inactivating one of the two X chromosomes in women. Evidence that has accumulated in the past 10 years suggests that cancer cells usurp this physiologic mechanism and use it to their benefit by inactivating tumor sup...

    journal_title:Annals of internal medicine

    pub_type: 杂志文章,评审

    doi:10.7326/0003-4819-134-7-200104030-00011

    authors: Santini V,Kantarjian HM,Issa JP

    更新日期:2001-04-03 00:00:00

  • Herpes simplex virus resistant to acyclovir. A study in a tertiary care center.

    abstract:STUDY OBJECTIVE:To determine the sensitivity of herpes simplex virus isolates to acyclovir and the importance of resistant isolates in hospitalized patients. DESIGN:Retrospective incidence cohort study. SETTING:All herpes simplex virus isolates cultured over 1 year from patients followed at a tertiary care center. P...

    journal_title:Annals of internal medicine

    pub_type: 杂志文章

    doi:10.7326/0003-4819-76-3-112-6-416

    authors: Englund JA,Zimmerman ME,Swierkosz EM,Goodman JL,Scholl DR,Balfour HH Jr

    更新日期:1990-03-15 00:00:00

  • Health care information and the protection of personal privacy: ethical and legal considerations.

    abstract::During the early 1990s, the U.S. government addressed the issue of providing universal health care to all its citizens. Although this issue has not been completely resolved, centralization of electronic data and sharing of health care information among insurers and providers have been pursued. The emergence of electro...

    journal_title:Annals of internal medicine

    pub_type: 杂志文章,评审

    doi:10.7326/0003-4819-127-8_part_2-199710151-00050

    authors: Gostin L

    更新日期:1997-10-15 00:00:00

  • Results of bone densitometry affect women's decisions about taking measures to prevent fractures.

    abstract:OBJECTIVE:To describe how the results of bone densitometry affect women's decisions about measures to prevent fractures and to determine whether labeling women as having below-normal bone density has adverse effects. DESIGN:Mail survey of a random sample of women. SETTING:Four community hospitals in the San Francisco...

    journal_title:Annals of internal medicine

    pub_type: 杂志文章

    doi:10.7326/0003-4819-116-12-990

    authors: Rubin SM,Cummings SR

    更新日期:1992-06-15 00:00:00

  • The demise of primary care: a diatribe from the trenches.

    abstract::Medical school graduates are avoiding primary care. The very aspects that once attracted students have been subverted. The breadth of practice that was once appealing has become the breadth of heavy-handed scrutiny, as politicians and business leaders have demanded quality--simplistically defined as dogmatic adherence...

    journal_title:Annals of internal medicine

    pub_type: 杂志文章

    doi:10.7326/0003-4819-150-10-200905190-00011

    authors: Norenberg DD

    更新日期:2009-05-19 00:00:00

  • Dementia in elderly outpatients: a prospective study.

    abstract::We prospectively studied the evaluation of dementia in 107 unselected outpatients; 83 had so-called "irreversible" dementias, including 74 who had an Alzheimer-type dementia. Fifteen patients had potentially reversible dementias, of which hypothyroidism and drug toxicity were the commonest causes. Distinguishing featu...

    journal_title:Annals of internal medicine

    pub_type: 杂志文章

    doi:10.7326/0003-4819-100-3-417

    authors: Larson EB,Reifler BV,Featherstone HJ,English DR

    更新日期:1984-03-01 00:00:00

  • Mechanical Symptoms and Arthroscopic Partial Meniscectomy in Patients With Degenerative Meniscus Tear: A Secondary Analysis of a Randomized Trial.

    abstract:BACKGROUND:Recent evidence shows that arthroscopic partial meniscectomy (APM) offers no benefit over conservative treatment of patients with a degenerative meniscus tear. However, patients who report mechanical symptoms (sensations of knee catching or locking) may benefit from APM. OBJECTIVE:To assess whether APM impr...

    journal_title:Annals of internal medicine

    pub_type: 杂志文章,多中心研究,随机对照试验

    doi:10.7326/M15-0899

    authors: Sihvonen R,Englund M,Turkiewicz A,Järvinen TL,Finnish Degenerative Meniscal Lesion Study Group.

    更新日期:2016-04-05 00:00:00

  • Minocycline-induced cell-mediated hypersensitivity pneumonitis.

    abstract:OBJECTIVE:To identify the cause of a hypersensitivity pneumonitis and to determine its pathogenesis. DESIGN:Case study. SETTING:Intensive care unit of a referral hospital. PATIENT:A 51-year-old man with chronic bronchitis who developed a hypersensitivity pneumonitis within 1 month after exposure to minocycline, amox...

    journal_title:Annals of internal medicine

    pub_type: 杂志文章

    doi:10.7326/0003-4819-117-6-476

    authors: Guillon JM,Joly P,Autran B,Denis M,Akoun G,Debré P,Mayaud C

    更新日期:1992-09-15 00:00:00

  • Pulmonary function and gastroesophageal reflux in systemic sclerosis.

    abstract:OBJECTIVE:To determine the relations among esophageal dysfunction, gastroesophageal reflux, and lung involvement in patients with systemic sclerosis. DESIGN:Retrospective review of esophageal motility, esophageal pH, and pulmonary function data. SETTING:University hospital outpatient clinic and community. PATIENTS:3...

    journal_title:Annals of internal medicine

    pub_type: 杂志文章

    doi:10.7326/0003-4819-121-1-199407010-00002

    authors: Troshinsky MB,Kane GC,Varga J,Cater JR,Fish JE,Jimenez SA,Castell DO

    更新日期:1994-07-01 00:00:00

  • Differences in generalists' and cardiologists' perceptions of cardiovascular risk and the outcomes of preventive therapy in cardiovascular disease.

    abstract:OBJECTIVE:To compare generalists' and cardiologists' estimates of baseline cardiovascular risk and the outcomes of preventive therapy. DESIGN:Cross-sectional mail survey using written case simulations of typical patients from primary prevention trials for hypercholesterolemia and isolated systolic hypertension, and te...

    journal_title:Annals of internal medicine

    pub_type: 杂志文章

    doi:10.7326/0003-4819-124-4-199602150-00005

    authors: Friedmann PD,Brett AS,Mayo-Smith MF

    更新日期:1996-02-15 00:00:00

  • Lost in transition: challenges and opportunities for improving the quality of transitional care.

    abstract::Transitional care has been defined as a set of actions designed to ensure the coordination and continuity of health care as patients transfer between different locations or different levels of care in the same location. Transitional care, which primarily concerns the relatively brief time interval that begins with pre...

    journal_title:Annals of internal medicine

    pub_type: 杂志文章

    doi:10.7326/0003-4819-141-7-200410050-00009

    authors: Coleman EA,Berenson RA

    更新日期:2004-10-05 00:00:00

  • Narrative review: lack of evidence for recommended low-density lipoprotein treatment targets: a solvable problem.

    abstract::Recent national recommendations have proposed that physicians should titrate lipid therapy to achieve low-density lipoprotein (LDL) cholesterol levels less than 1.81 mmol/L (<70 mg/dL) for patients at very high cardiovascular risk and less than 2.59 mmol/L (<100 mg/dL) for patients at high cardiovascular risk. To exam...

    journal_title:Annals of internal medicine

    pub_type: 杂志文章,评审

    doi:10.7326/0003-4819-145-7-200610030-00010

    authors: Hayward RA,Hofer TP,Vijan S

    更新日期:2006-10-03 00:00:00

  • Hidden Curricula, Ethics, and Professionalism: Optimizing Clinical Learning Environments in Becoming and Being a Physician: A Position Paper of the American College of Physicians.

    abstract::Much of what is formally taught in medicine is about the knowledge, skills, and behaviors required of a physician, including how to express compassion and respect for patients at the bedside. What is learned, however, includes not only admirable qualities but also behaviors and qualities that are inconsistent with eth...

    journal_title:Annals of internal medicine

    pub_type: 杂志文章

    doi:10.7326/M17-2058

    authors: Lehmann LS,Sulmasy LS,Desai S,ACP Ethics, Professionalism and Human Rights Committee.

    更新日期:2018-04-03 00:00:00

  • Prevention of plaque rupture: a new paradigm of therapy.

    abstract::Acute coronary syndromes--unstable angina, myocardial infarction, and sudden cardiac death--are caused by acute disruption of an unstable coronary atheroma. Unstable plaques have three histologic characteristics: a large lipid core, many inflammatory cells, and a thin fibrous cap. Because the unstable plaque is not ne...

    journal_title:Annals of internal medicine

    pub_type: 杂志文章,评审

    doi:10.7326/0003-4819-137-10-200211190-00012

    authors: Forrester JS

    更新日期:2002-11-19 00:00:00

  • The association between cardiorespiratory fitness and impaired fasting glucose and type 2 diabetes mellitus in men.

    abstract:BACKGROUND:Several studies show an inverse association between self-reported physical activity and type 2 diabetes. It is not known whether physical activity or cardiorespiratory fitness is associated with the onset of objectively determined impaired fasting glucose and type 2 diabetes. OBJECTIVE:To determine whether ...

    journal_title:Annals of internal medicine

    pub_type: 杂志文章

    doi:10.7326/0003-4819-130-2-199901190-00002

    authors: Wei M,Gibbons LW,Mitchell TL,Kampert JB,Lee CD,Blair SN

    更新日期:1999-01-19 00:00:00

  • Screening for type 2 diabetes mellitus in adults: U.S. Preventive Services Task Force recommendation statement.

    abstract:DESCRIPTION:Updated U.S. Preventive Services Task Force (USPSTF) recommendation about screening for type 2 diabetes mellitus in adults. METHODS:To estimate the balance of benefits and harms of screening, the USPSTF updated its 2003 evidence review, adding evidence from new trials as well as updates on earlier studies....

    journal_title:Annals of internal medicine

    pub_type: 杂志文章,实务指引

    doi:10.7326/0003-4819-148-11-200806030-00007

    authors: U.S. Preventive Services Task Force.

    更新日期:2008-06-03 00:00:00

  • Brief communication: National quality-of-care standards in home-based primary care.

    abstract:BACKGROUND:Home-based primary care for homebound seniors is complex, and practice constraints are unique. No quality-of-care standards exist. OBJECTIVE:To identify process quality indicators that are essential to high-quality, home-based primary care. DESIGN:An expert development panel reviewed established and new qu...

    journal_title:Annals of internal medicine

    pub_type: 杂志文章

    doi:10.7326/0003-4819-146-3-200702060-00008

    authors: Smith KL,Soriano TA,Boal J

    更新日期:2007-02-06 00:00:00

  • In the clinic. Clostridium difficile Infection.

    abstract::This issue provides a clinical overview of Clostridium difficile infection focusing on prevention, diagnosis, treatment, practice improvement, and patient information. Readers can complete the accompanying CME quiz for 1.5 credits. Only ACP members and individual subscribers can access the electronic features of In th...

    journal_title:Annals of internal medicine

    pub_type: 杂志文章,评审

    doi:10.7326/0003-4819-153-7-201010050-01004

    authors: Hessen MT

    更新日期:2010-10-05 00:00:00

  • A high molecular weight antigen in Legionnaires' disease bacterium: isolation and partial characterization.

    abstract::We isolated a high molecular weight antigen of the Legionnaires' disease (LD) bacterium by column chromatography. The antigen was composed of 35% carbohydrate, 2.6% protein, 1.8% phospholipid, and 1% 2-keto-3-deoxyoctonate and was important in the host's antibody response because it inhibited the indirect immunofluore...

    journal_title:Annals of internal medicine

    pub_type: 杂志文章

    doi:10.7326/0003-4819-90-4-638

    authors: Johnson W,Elliott JA,Helms CM,Renner ED

    更新日期:1979-04-01 00:00:00

  • Using serum creatinine to estimate glomerular filtration rate: accuracy in good health and in chronic kidney disease.

    abstract:BACKGROUND:The National Kidney Foundation has advocated the use of the abbreviated Modification of Diet in Renal Disease (MDRD) equation to estimate glomerular filtration rate (GFR) from serum creatinine measurements in clinical laboratories. However, healthy persons were not included in the development of the MDRD equ...

    journal_title:Annals of internal medicine

    pub_type: 杂志文章

    doi:10.7326/0003-4819-141-12-200412210-00009

    authors: Rule AD,Larson TS,Bergstralh EJ,Slezak JM,Jacobsen SJ,Cosio FG

    更新日期:2004-12-21 00:00:00

  • Critical pathways as a strategy for improving care: problems and potential.

    abstract::In an era of increasing competition in medical care, critical pathway guidelines have emerged as one of the most popular new initiatives intended to reduce costs while maintaining or even improving the quality of care. Developed primarily for high-volume hospital diagnoses, critical pathways display goals for patients...

    journal_title:Annals of internal medicine

    pub_type: 杂志文章

    doi:10.7326/0003-4819-123-12-199512150-00008

    authors: Pearson SD,Goulart-Fisher D,Lee TH

    更新日期:1995-12-15 00:00:00

  • In type 2 diabetes, some glucose-lowering drugs reduce HbA1c more than others; drugs do not differ for mortality.

    abstract:SOURCE CITATION:Tsapas A, Avgerinos I, Karagiannis T, et al. Comparative effectiveness of glucose-lowering drugs for type 2 diabetes: a systematic review and network meta-analysis. Ann Intern Med. 2020;173:278-86. 32598218. ...

    journal_title:Annals of internal medicine

    pub_type: 评论,杂志文章

    doi:10.7326/ACPJ202011170-053

    authors: Gandhi GY

    更新日期:2020-11-17 00:00:00

  • Patient-physician connectedness and quality of primary care.

    abstract:BACKGROUND:Valid measurement of physician performance requires accurate identification of patients for whom a physician is responsible. Among all patients seen by a physician, some will be more strongly connected to their physician than others, but the effect of connectedness on measures of physician performance is not...

    journal_title:Annals of internal medicine

    pub_type: 杂志文章,多中心研究

    doi:10.7326/0003-4819-150-5-200903030-00008

    authors: Atlas SJ,Grant RW,Ferris TG,Chang Y,Barry MJ

    更新日期:2009-03-03 00:00:00

  • Substituting walnuts for monounsaturated fat improves the serum lipid profile of hypercholesterolemic men and women. A randomized crossover trial.

    abstract:BACKGROUND:It has been reported that walnuts reduce serum cholesterol levels in normal young men. OBJECTIVE:To assess the acceptability of walnuts and their effects on serum lipid levels and low-density lipoprotein (LDL) oxidizability in free-living hypercholesterolemic persons. DESIGN:Randomized, crossover feeding t...

    journal_title:Annals of internal medicine

    pub_type: 临床试验,杂志文章,随机对照试验

    doi:10.7326/0003-4819-132-7-200004040-00005

    authors: Zambón D,Sabaté J,Muñoz S,Campero B,Casals E,Merlos M,Laguna JC,Ros E

    更新日期:2000-04-04 00:00:00

  • Meningococcal polysaccharide vaccines. Recommendation of the Public Health Service Advisory Committee on Immunization Practices, Center for Disease Control, United States Department of Health, Education, and Welfare, Atlanta, Georgia.

    abstract::Polysaccharide vaccines against diseases caused by Neisseria meningitidis serogroups A and C meningococci are now licensed in the United States. They are prepared as monovalent and as bivalent antigens. This statement summarizes available information on these antigen and offers guidance regarding their role in the con...

    journal_title:Annals of internal medicine

    pub_type: 杂志文章

    doi:

    authors:

    更新日期:1976-02-01 00:00:00