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Limitations of Canadian Cardiovascular Society classification of angina pectoris

Cox JL, Naylor CD, Johnstone DE. Am J Cardiol. 1994; 74(3):276-7.


The Canadian Cardiovascular Society (CCS) classification of angina pectoris has been widely adopted since its introduction in the 1970s. Recent appraisals of this classification scheme have identified a number of concerns, including (1) the unproven assumption of symptomatic or physiologic equivalence among diverse levels of different activities within individual angina grades, (2) the fact that the scale is potentially cumbersome were one to work through the full permutations of symptoms and qualifiers for each patient, and (3) the weak relation between symptom severity as captured by the scale and anatomic disease or prognosis. To highlight patients' perceptions of their own functional limitations and to assess how such introspection has compared with the categorization accorded by medical personnel using the CCS scale, we developed a patient disability score, a 4-grade scale that simply refers to "no," "mild," "moderate," or "severe limitation of desired activities."

Keywords: Cardiovascular diseases Health informatics

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