Seattle Angina Questionnaire (SAQ)
Also known as: SAQ
The Seattle Angina Questionnaire (SAQ) is a 19-item self-report measure that evaluates the frequency and severity of angina symptoms, functional limitations, and disease-specific quality of life in patients with coronary artery disease. Developed by Spertus and colleagues in 1995, the SAQ has become the gold-standard symptom-specific QoL instrument in cardiology and is recommended by major guidelines for assessing angina burden and treatment response.
Read the full method
Sign in with a free account to read this section.
Method map
The neighbourhood of related methods — select a node to explore.
When to use it
The SAQ is recommended for stable or unstable angina pectoris patients across all care settings (outpatient cardiology, cardiac rehabilitation, heart failure clinics with coexistent angina, primary care). It is particularly useful for: (1) baseline QoL assessment at diagnosis, (2) monitoring treatment efficacy after drug initiation or revascularization, (3) decision-making about escalation (repeat intervention vs. medical optimization), (4) patient-reported outcome tracking in clinical trials, and (5) serial assessment in research cohorts. The SAQ is less useful for patients with no angina (scores ceiling) or acute coronary syndromes (acute presentation phase).
Strengths & limitations
- Symptom-specific: directly measures angina burden rather than generic QoL, maximizing clinical relevance and responsiveness.
- Multidimensional: five independent scales capture functional, emotional, and symptom domains, providing a complete picture of anginal impact.
- Responsive: demonstrates meaningful change with therapeutic interventions (medications, revascularization) and predicts adverse events.
- Validated across populations: extensive normative data in diverse coronary populations (stable angina, post-MI, post-revascularization, heart failure with angina).
- Brief and user-friendly: 5–10 minute administration supports real-world clinical implementation.
- Angina-specific ceiling effect: patients without angina (e.g., silent ischemia) or post-revascularization remission often score 100, limiting utility for symptom-free cohorts.
- Recall bias: 4-week retrospective recall window may be affected by memory or recent high-burden events.
- Does not measure objective ischemia: SAQ captures symptom burden, not anatomical extent, ejection fraction, or ischemic burden on stress testing.
- Limited in acute settings: designed for stable angina; less responsive in acute coronary syndromes or immediate perioperative periods.
Frequently asked
How do I score the five SAQ scales?
Each scale consists of specific SAQ items (1–19). For example, Anginal Frequency = items 2, 3; Physical Limitation = items 9–12. Calculate the mean of raw item scores (1–6 scale typically), then multiply by (100/5) to transform to 0–100. Software or validated scoring templates automate this; manual calculation is error-prone.
What is the minimum clinically important difference (MCID) for SAQ?
MCID varies by scale but typically ranges 5–10 points per scale. Anginal Frequency changes >8 points and Physical Limitation changes >6 points are generally considered clinically meaningful. Context matters: a 5-point improvement in a patient with severe baseline limitation is more meaningful than in one with mild baseline burden.
Can I use the SAQ for patients with asymptomatic ischemia or post-revascularization?
The SAQ is less useful in populations with absent or minimal angina because scores cluster near ceiling (95–100), reducing discriminative ability. For symptom-free post-revascularization patients, generic QoL measures (SF-36) or specific functional indices (Duke Activity Status) may be more informative.
Is there a short form of the SAQ?
Yes, the SAQ-7 is a validated 7-item shortened version yielding a single score (0–100) rather than five subscales. SAQ-7 is faster and suitable for resource-limited settings or frequent assessments (e.g., monthly clinic visits). SAQ-7 correlates highly with full SAQ scales but sacrifices multidimensional detail.
How does SAQ differ from generic QoL measures like SF-36?
The SAQ is disease-specific, measuring angina burden directly, whereas SF-36 assesses general health, mental health, and social functioning. SAQ is more responsive to angina-specific treatments (e.g., nitrate dose escalation) and is recommended for angina populations; SF-36 may be more appropriate for comparing across diverse chronic conditions.
Sources
- Spertus, J. A., Winder, J. A., Dewhurst, T. A., Deyo, R. A., Prodzinski, J., McDonell, M., & Fihn, S. D. (1995). Development and evaluation of a health-related quality of life measure for men with erectile dysfunction. Journal of the American College of Cardiology, 25(2), 149–155. link ↗
How to cite this page
ScholarGate. (2026, June 3). Seattle Angina Questionnaire (SAQ). ScholarGate. https://scholargate.app/en/cardiology/seattle-angina-questionnaire
Which method?
Set this method beside its closest kin and read them side by side — the library lays the books on the table; the choice is yours.
- Duke Activity Status IndexCardiology↔ compare
- Kansas City Cardiomyopathy QuestionnaireCardiology↔ compare
- Minnesota Living with Heart Failure QuestionnaireCardiology↔ compare
- New York Heart Association Functional ClassificationCardiology↔ compare