ArticleJournal of the American Heart Association2019
Angina Severity, Mortality, and Healthcare Utilization Among Veterans With Stable Angina.
Article in Journal of the American Heart Association, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 16 papers, 2 of them syntheses that pooled it.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
16 citing papers in PubMed, 2 syntheses or guidelines pooled it, 31 citations in OpenAlex.
- Natural language processing with machine learning methods to analyze unstructured patient-reported outcomes derived from electronic health records: A systematic review.Artificial intelligence in medicine · 2023Pooled it
- Systematic review of current natural language processing methods and applications in cardiology.Heart (British Cardiac Society) · 2022Pooled it
- Minimal clinically important differences in patient-reported outcomes after coronary artery bypass surgery in the arterial revascularization trial.European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery · 2024Trial
- Ticagrelor versus clopidogrel in Chinese patients with coronary artery disease: a retrospective real-world study.Scientific reports · 2025Article
- Impact of an interactive CTCA/FFRThe international journal of cardiovascular imaging · 2025Article
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- Effectiveness of Device-Guided Breathing in Chronic Coronary Syndrome: A Randomized Controlled Study.Acta Cardiologica Sinica · 2023Article
- No Healthcare Utilization and Death.Journal of general internal medicine · 2022Article
- Reversing mitochondrial defects in aged hearts: role of mitochondrial calpain activation.American journal of physiology. Cell physiology · 2022Article
- Contemporary Risk Stratification of Acute Coronary Syndrome.US cardiology · 2022Review
- Article
- Blood pressure variability in patients with angina and non-obstructive coronary artery disease.Journal of human hypertension · 2021Article
- Article
- Comparison of functional exercise capacity, quality of life and respiratory and peripheral muscle strength between patients with stable angina and healthy controls.The Journal of international medical research · 2020Article
- Deafening Silence: The Lack of Structured Patient Symptoms in Clinical Documentation of Angina.Journal of the American Heart Association · 2019Article
- Angina Severity, Mortality, and Healthcare Utilization Among Veterans With Stable Angina.Journal of the American Heart Association · 2019Article
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Authors and funding
13 authors at 6 institutions in 1 country.
Funding
Abstract
Background Canadian Cardiovascular Society (CCS) angina severity classification is associated with mortality, myocardial infarction, and coronary revascularization in clinical trial and registry data. The objective of this study was to determine associations between CCS class and all-cause mortality and healthcare utilization, using natural language processing to extract CCS classifications from clinical notes. Methods and Results In this retrospective cohort study of veterans in the United States with stable angina from January 1, 2006, to December 31, 2013, natural language processing extracted CCS classifications. Veterans with a prior diagnosis of coronary artery disease were excluded. Outcomes included all-cause mortality (primary), all-cause and cardiovascular-specific hospitalizations, coronary revascularization, and 1-year healthcare costs. Of 299 577 veterans identified, 14 216 (4.7%) had ≥1 CCS classification extracted by natural language processing. The mean age was 66.6±9.8 years, 99% of participants were male, and 81% were white. During a median follow-up of 3.4 years, all-cause mortality rates were 4.58, 4.60, 6.22, and 6.83 per 100 person-years for CCS classes I, II, III, and IV, respectively. Multivariable adjusted hazard ratios for all-cause mortality comparing CCS II, III, and IV with those in class I were 1.05 (95% CI, 0.95-1.15), 1.33 (95% CI, 1.20-1.47), and 1.48 (95% CI, 1.25-1.76), respectively. The multivariable hazard ratio comparing CCS IV with CCS I was 1.20 (95% CI, 1.09-1.33) for all-cause hospitalization, 1.25 (95% CI, 0.96-1.64) for acute coronary syndrome hospitalizations, 1.00 (95% CI, 0.80-1.26) for heart failure hospitalizations, 1.05 (95% CI, 0.88-1.25) for atrial fibrillation hospitalizations, 1.92 (95% CI, 1.40-2.64) for percutaneous coronary intervention, and 2.51 (95% CI, 1.99-3.16) for coronary artery bypass grafting surgery. Conclusions Natural language processing-extracted CCS classification was positively associated with all-cause mortality and healthcare utilization, demonstrating the prognostic importance of anginal symptom assessment and documentation.
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